Chapter 7 Bilateral endophthalmitis risk and intracameral prophylactic antibiotics ∗

The most important risk of immediately sequential bilateral cataract surgery (ISBCS) that slowed its adoption since the discovery of the germ theory of disease is that of bilateral simultaneous postoperative endophthalmitis (BSPOE). Many measures are taken to ensure that the risk of postoperative endophthalmitis (POE) is minimized, as detailed in the International Society of Bilateral Cataract Surgeons General Principles for Excellence in ISBCS 2009 (Ch 16.9 Canada, Appendix 1). However, the single most important advancement was the introduction of intracameral prophylactic antibiotics (IC ABs) and their general adoption at the turn of the 21st century, which has significantly reduced rates of POE. It required multiple iterations to develop current protocols of antibiotic choice and concentrations, but IC ABs now constitute an important independent protective factor against POE. This is even more critical in the setting of ISBCS, making the negligible risk of BSPOE acceptable.