Study of Antibiotic Prophylaxis for Endophthalmitis Following Cataract Surgery

February 11, 2016 updated by: City, University of London

Antibiotic Prophylaxis for Cataract Surgery Version 7e January 22 2003

Cataract is the most important cause of visual impairment and decreased mobility in the elderly. While surgery is usually successful, it is also responsible for permanent loss of vision in up to 0.1% of patients due to severe post-operative infection (endophthalmitis). Because of this risk, surgery is typically performed on one eye at a time leaving the patient with a monocular cataract causing considerable visual impairment with reduction in mobility and quality of life. A second operation is required which often takes place up to one year later.

It is not known at present whether the post-operative complication of endophthalmitis can be prevented by perioperative use of antibiotics. This randomised study (masked and placebo-controlled for topical levofloxacin and unmasked for intracameral injection of cefuroxime) sets out to test in 4 groups, each of 8,750 cataract surgery patients, if either topical antibiotic (levofloxacin) perioperatively or an intraocular (intracameral) injection of antibiotic (cefuroxime) at the end of phacoemulsification cataract surgery or the combination provides effective prophylaxis of post-operative infection (endophthalmitis) compared to controls in whom perioperative antibiotics are not used. The result will provide a scientific basis for prophylaxis of infection (endophthalmitis) following cataract surgery in Europe as well as an accurate figure for the incidence of endophthalmitis following phacoemulsification cataract surgery in Europe for the first time.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Cataract extraction with intra-ocular lens implantation is the most commonly performed surgical procedure in the elderly population in Europe. The frequency varies in different European Union (EU) countries involving 2 to 7 per 1000 population per annum. A population with an ever-increasing proportion of the elderly is advancing this figure with numbers requiring surgery expected to increase by 70% by 2006. While technical advances (phacoemulsification) have enhanced the efficacy of the procedure, the possibility of serious post-operative infection with loss of vision remains the most important unsolved problem.

In the absence of scientific evidence, the European Society of Cataract and Refractive Surgeons (ESCRS) wishes to determine whether one currently developed method of delivering antibiotics intraocularly in Sweden is of benefit compared to surgery without the use of perioperative antibiotics, as currently practised in many European centres, or to the use of frequent application of topical antibiotic drops perioperatively. The ESCRS also wishes to assess possible risk factors for later endophthalmitis.

This study requires four groups of 8,750 patients - 35,000 in all - to demonstrate reductions of currently reported rates of endophthalmitis (approximately 0.3%) in patients where no intraocular antibiotics are used, or where they are used by the subconjunctival route. Other studies using intraocular vancomycin have reported results as low as 0.05%, but these studies were not standardised or controlled and the results were anecdotal. In addition, vancomycin should not be used for routine prophylaxis and should only be used as the antibiotic of 'last resort'.

This multi-centre randomised study involves 24 operating units in 8 EU countries (Austria, Belgium, England, Germany, Italy, Poland, Portugal and Spain) and Turkey. Results in 8,750 patients receiving an intracameral injection of antibiotic (cefuroxime) at the end of surgery will be compared to 8,750 patients receiving topical antibiotic (levofloxacin) prophylaxis before and at the end of surgery, 8,750 patients receiving the combination and 8,750 patients receiving neither regime; in addition, all patients will receive povidone iodine antiseptic prophylaxis prior to surgery and post-operative levofloxacin from days 1 to 6 to prevent wound infection.

This group size will be sufficiently large to ensure at least 80% statistical power to detect a reduction of incidence from 0.25% to 0.08% using 5% significance level tests.

Surgical data from all patients will be collected directly into computers based within each operating theatre and transmitted to a central server in Glasgow (University of Strathclyde). Follow-up data for the presence or absence of endophthalmitis will be collected from all patients at post-operative visits and similarly recorded on computers for transmission to the central server. Sophisticated techniques will be used to check all data as it is uploaded.

Study Type

Interventional

Enrollment

35000

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Austria
      • Salzburg, Austria
        • University Eye Clinic, Paracelsus Private Medical University
  • Belgium
      • Antwerp, Belgium
        • University Hospital Antwerp, UZA Ophthalmology
      • Gent, Belgium
        • University of Gent, Universitaire Zeikenhuis
      • Ieper, Belgium
        • Jan Yperman ziekenhuis
      • Liege, Belgium
        • Centre Hospitalier Universitaire
      • Melveren, Belgium
        • Oogheelkunde
  • Germany
      • Ahaus, Germany
        • Augenklinik Ahaus
  • Italy
      • Desenzano, Italy
        • Azienda Ospedaliera di Desenzano del Garda
      • Verona, Italy
        • Ospedale Borgo Trento
  • Poland
      • Warsaw, Poland
        • Kierownik Katedry i Kliniki
  • Portugal
      • Coimbra, Portugal
        • University Hospital
  • Spain
      • Alicante, Spain
        • Instituto Oftalmologico VISSUM
      • La Candelaria, Tenerife, Spain
        • La Candelaria University Hospital
      • La Laguna, Tenerife, Spain
        • Hospital Universitario de Canarias
      • Madrid, Spain
        • Hospital Oftalmologico Internacional
  • Turkey
      • Izmir, Turkey
        • Dokuz Eylul University
  • United Kingdom
      • Axminster, United Kingdom
        • Axminster Hospital
      • Exeter, United Kingdom
        • West of England Eye Unit, Royal Devon & Exeter Hospital (Wonford)
      • Ipswich, United Kingdom
        • Ipswich Hospital
      • London, United Kingdom
        • St. Thomas' Hospital
      • London, United Kingdom
        • Moorfields Eye Outreach Unit, Northwick Park Hospital
      • London, United Kingdom
        • Moorfields Eye Outreach Unit, St. George's Hospital
      • Oxford, United Kingdom
        • Oxford Eye Hospital
      • Sunderland, United Kingdom
        • Sunderland Eye Infirmary

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

16 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • All patients, including diabetics, undergoing routine cataract surgery in each unit taking part in the study

Exclusion Criteria:

  • Patients who do not wish to take part in the trial
  • Patients allergic to penicillins and cephalosporins.
  • Long-term nursing home patients
  • Patients with only one eye
  • Pregnancy.
  • Children less than 18 years old.

  • All severely 'at-risk' groups for infection including:

    • Severe atopic keratoconjunctivitis;
    • Severe active blepharitis;
    • Ocular cicatricial pemphigoid.
  • Patients with complicated cataracts such as traumatic or subluxated
  • Patients having combined operations with cataract surgery such as trabeculectomy or a corneal graft.
  • Patients known to be allergic to povidone iodine (very rare) or any other known hypersensitivity to any components of the study medications.
  • Patients who are incapacitated mentally and incapable of giving consent.
  • Patients with severe thyroid disease
  • Open infection anywhere, infection of lacrimal drainage channels or infection around the eye

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Factorial Assignment
  • Masking: Double

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Prevention of post-operative endophthalmitis following phacoemulsification cataract surgery in Europe due to use of perioperative antibiotics
Incidence of endophthalmitis in Europe following phacoemulsification cataract surgery

Secondary Outcome Measures

Outcome Measure
Effect of risk factors on the presentation of endophthalmitis in Europe following phacoemulsification cataract surgery

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

City, University of London

Collaborators

Santen Gmbh
The European Society of Cataract and Refractive Surgeons(ESCRS)

Investigators

  • Study Chair: Peter Barry, FRCS, ESCRS (European Society of Cataract and Refractive Surgeons)
  • Principal Investigator: Mary D'Ardis, ESCRS

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

September 1, 2003

Study Completion

May 1, 2006

Study Registration Dates

First Submitted

August 26, 2005

First Submitted That Met QC Criteria

August 26, 2005

First Posted (Estimate)

August 29, 2005

Study Record Updates

Last Update Posted (Estimate)

February 12, 2016

Last Update Submitted That Met QC Criteria

February 11, 2016

Last Verified

June 1, 2007

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • MREC Ref. no. 02/5/46

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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