Re: cataract surgery antiobiotics
by doogles on January 30th, 2018, 5:42 am
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.