cataract surgery antiobiotics

[zetreque]

A relative is undergoing cataract surgery this Wednesday to remove the cataract and install a new intraocular lens.

One of the drugs she is supposed to take is an antibiotic the first week. I just researched this antiobiotic Besivance, and see that it's used to treat conjunctivitis aka pink eye and "inhibit the production of pro-inflammatory cytokines in vitro". So basically they give all cataract surgery patients this antibiotic whether or not they have an infection. Isn't this the same story of the problem with antibiotics and resistance? Farmers instead of treating just their sick cattle will give all cattle antibiotics.

The most concerning study I found however is this one which if I am understanding it right shows the drug to contribute to severe corneal edema, glaucomatous and toxic damage.

The study was rabbits which had each "eye was injected with 0.1 mL of the study medication."
It would be helpful to understand what is meant by the word "injection" as the besivance medication is eyedrops. The study calls for more research with lower doses of medication.

An anterior chamber toxicity study evaluating Besivance, AzaSite, and Ciprofloxacin
https://www.ncbi.nlm.nih.gov/pubmed/20678751

On the other hand, two studies claim that it's fairly safe. https://www.ncbi.nlm.nih.gov/pubmed/24637269

Given this information, would you choose to use the besivance medication or not?

[Serpent]

I think this situation is more like a vaccine, or taking an acid-reducer before a meal, or a pain-killer before the last one's worn off, to prevent symptoms.
Since we're only going to have cataract surgery that one time, the problem of building up resistance shouldn't come up.
I just got my appointment date for an assessment. The surgery may be some months off yet, but I sure look forward to having my deteriorating sight stabilized. I'll take whatever they tell me to!

[zetreque]

She is scheduled for the first week an antiobiotic. firsts 2-3 weeks steroids, and 4 weeks of painkiller.
She is getting the standard lens and not the one to do multiple distances due to her job and not wanting to put up with halos from lighting.

It looks like while it is possible to change out IOL's in the future if someone wants to change prescription or upgrade, it's not desired because it is difficult to remove a plastic lens from inside the eye. They remove the cataract by cutting it down into pieces with a laser so that's much easier.

As always, it's weighing the risks vs benefits. Her eyesight and health isn't really that bad IMO so the risks for these medications are a little higher when it comes to the risk benefit analysis.

The steroid they prescribed for example I found conflicting data on it causing damage due to intraocular pressure increases. It appears they increase the strength of these medications so that users can have lower frequency of administration in order to keep patients in compliance (actually taking them correctly).

[bangstrom]

I had a recent cataract surgery and took Besivance eye drops as a prophylactic against infection. I wouldn’t want to undergo any surgery without antibiotics because it is impossible to sterilize body surfaces so the chances of infection are high with any invasive procedure. Being cut open is not a healthy condition that needs no attention and it is dangerous to wait until after an infection develops before treating it.

[doogles]

Zetrique, I just had both eyes operated on for cataracts in December, 2 weeks apart. Fantastic results, totally painless (so I don’t understand the ‘painkillers for your relative). The only negative was the nuisance of putting in eye drops for 6 weeks (4 weeks anti-inflammatory drops for each eye.

I’m was personally happy with the use of an antibiotic (Tobramycin in my case) as a prophylactic for a week to prevent infections in my eyes. Eyes are very complex structures and even if an infection is identified within hours, the minor damage inflicted on the eye by the time antibiotics take effect to reverse it (hours or days), could be enough to distort vision. In contrast, if an infection occurs in a skin incision anywhere in the body, a worse scar due to some hours of damage is not really an issue.

I agree with Serpent who made the point that this is a case for prevention rather than chase-up cure.

In principle if an antibiotic is applied at the FULL dose for the FULL period it takes to kill all sensitive bacteria, then antibiotic resistance development cannot occur. That’s the way I see it.

The problem with antibiotics used in livestock feeds is that they are given in small quantities and virtually invite resistant species to prevail. Fortunately, as I understand it, laws restrict the use of human therapeutic antibiotics from livestock use.

I also think that the dexamethasone drops to prevent oedema secondary to the surgery is a good idea. Any degree of oedema could compromise the healing of vital eye tissues. It was a good drug during my practice days and did work very effectively in the prevention of massive swelling following trauma.

I can understand your concerns Zetrique after reading about the rabbit experiment. I was involved in the establishment of one of the earliest Animal Experimentation Ethics Committees in the world and helped to establish, as well as participate in a couple of others. I’m sensitive to animal welfare. In this case, 20 rabbits were subjected to restraint and intra-ocular injections of solutions. The full article has a price, so I may be missing something. Hopefully the rabbits received local anaesthetic drops prior to the injections.

An aspect of this experiment that concerns me is whether there was a valid reason for needing to inject substances into the anterior chamber. In 25 years I never saw an infection in the anterior chamber of an eye that would require an intraocular injection. I did see a panophthalmia in a cattle virus disease called Bovine Malignant Catarrhal Fever but it was 100% fatal anyhow. I did see stacks of cases of conjunctivitis, and severe kerato-conjunctivitis with and without ulceration, but the treatment for the latter needed more than an injection into the anterior chamber. Unless there was evidence of such a disease in human beings, this experiment would never have taken place under my supervision.

Application of drops may be okay, but rather than use 20 rabbits straight off, my committees would have allowed cautious pilot experiments wherein 2 rabbits at the most would have been for used each of the experimental drugs to check for adverse effects, before adding the others to get the numbers.

It’s hard to figure out from the Abstract what exactly was done. I get the impression that the Besivance and Azasite injection sites were covered with DuraSite bioadhesive, and that it was this bioadhesive that received the credit for the severe oedema. I could be wrong, but to me it appears that the rabbits had to put up with 24 to 48 hours of eye discomfort without any evidence as to whether the Besivance or AzaSite were safe in their own right when injected into the anterior chamber.

Anyhow, the second paper you cited suggests that the antibiotic drops are okay.

Your rele- should have no problems. The op is performed under tranquiliser and nerve blocks, takes no more than 15 minutes for each eye and you go home after having a cup of tea and sandwich and staying under post-op supervision for a couple of hours.

My only query to the ophthalmologist was why he used the dexamethasone for a month afterwards. He had no evidence-based reason but just ‘felt’ happy about that length of time. I went along with it because it was harmless. I chose long-distance lenses for driving and because it’s easy to have glasses around where I read or use a computer, but surprisingly, I can now read 12-point fonts without glasses.

All colours become surprisingly vivid, but the downside is that you no longer see yourself or your own skin in subdued light (like in the romantic movies). You see every wrinkle and blemish on your’s and everybody else’s skin.

[Serpent]

Thanks, Doogles, that's reassuring. I have a friend who had both eyes done a couple of years ago; she says it's the proverbial dawdle. She can drive and watch tv without glasses and just needs the $2 generic ones for reading or sewing. She keeps six pairs of those all over the house wherever she might need them.

I just spent $200 on the last pair of distance glasses, only sort-of-good (the computer screen is in between distance and reading; hence all the typos), that I was told would have to last 8-10 months on the waiting list. That was only a month ago, and I got an app't for next week. What a waste!

[zetreque]

Thank you all for your responses!

Yes the Durasite bit was very confusing to me as well. I'd like to ask the doctor if he uses that.

For future information, the other drugs prescribed in her case are Durezol steroid and llevro painkiller.

A note of future caution too. Make sure you are actually prescribed the correct drug!!!!
There are cases where patients were prescribed Durasal instead of Durezol which is a completely different drug.

What’s in a drug name?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3676244/