Is topical antibiotic use necessary to prevent surgical site infection following oculoplastic surgery?

PURPOSE: To assess whether oculoplastic surgeries can be performed without any topical and systemic antibiotics, in a "100% antibiotic free" fashion. METHOD: We conducted a multicenter retrospective study between November 2017 and December 2022. Patients who underwent an oculoplastic procedure were screened. Patients who received preoperative or postoperative systemic antibiotics were excluded. Intraoperative IV antibiotics were allowed. Patients were divided into two groups: those who were treated with local antibiotics ointments (LATB group) and those who were treated without local antibiotics ointments (LATB free group) postoperatively. The primary outcome was the incidence of surgical site infections (SSI). The relationship between the use of local antibiotics and the occurrence of SSI was assessed using Fisher's exact test. The alpha risk was set to 5% and two-tailed tests were used. RESULTS: Among the 947 procedures included, 617 were included in the LATB group and 330 in the LATB free group. 853 and 80 procedures were classified Altemeier class 1 (clean) and class 2 (clean-contaminated) surgeries, respectively. Overall, 310 (32.73%) procedures were performed without any systemic nor topical antibiotics (100% antibiotic free fashion). SSI occured in four (4/617; 0.65%) and five (5/330; 1.52%) procedures in the LATB and LATB free group respectively, without any statistical difference between the groups (p = 0.290). A subgroup analysis was carried out by excluding the procedures performed under prophylactic intraoperative intravenous antibiotics and did not reveal any statistical difference between the two groups (p = 0.144). All SSI patients were treated with systemic antibiotics with favorable outcomes. Postoperative wound dehiscence was the only risk factor associated with postoperative SSI (p = 0.002). CONCLUSION: This study suggests that performing a "100% antibiotic free" oculoplastic surgery without systemic and topical antibiotics is reasonable in Altemeier class 1 and class 2 procedures.

[Orbital cellulitis and endophthalmitis after cataract surgery]. / Cellulite orbitaire avec endophtalmie après chirurgie de cataracte.

Orbital cellulitis with endophthalmitis is an extremely uncommon complication following ocular surgery. We report the case of 38 year-old man who developed orbital cellulitis and endophthalmitis after extracapsular extraction and posterior chamber implant placement for cataract secondary to radiotherapy. Phacoextraction was performed under general anaesthesia and was uneventful. Three days postoperatively, the patient was examined for a reduced visual acuity and lid swelling in the operated eye. Ocular examination has shown signs of endophthalmitis and orbital cellulitis, which was confirmed by a computed tomographic scan. Bacteriology cultures were positive for a Streptococcus pneumoniae. The ocular infection evolved towards phthisis bulbi with no light perception 45 days after surgery. Enucleation with orbital implant was performed.