Effect of Prophylactic Topical Antibiotics on Rates of Infectious Complications After Strabismus Surgery: A Large Database Study.

Objective: Not all strabismus surgeons use prophylactic topical antibiotics postoperatively because they may be poorly tolerated, costly, and may increase antimicrobial resistance. The purpose of the study is to assess the effect of postoperative topical antibiotics on the rate of surgical site infections following strabismus surgery.

Design: Retrospective clinical cohort study.

Participants: Patients who underwent strabismus surgery in the past 20 years. Patients who were or were not prescribed postoperative topical antibiotics comprised the study and control groups, respectively.

Methods: This study was conducted using data from TriNetX, an international electronic health-record registry containing data for over 130 million patients. Strabismus surgery patients were identified using CPT codes. The prescription of eye topical antibiotics and the frequency of surgical site infections were identified by RxNorm and ICD-10 codes, respectively. Analysis was conducted using the measures of association feature of TriNetX. Patient demographics such as age, sex, and race were recorded based on their presence in the electronic records system.

Main Outcome Measure: Development of endophthalmitis, orbital and preseptal cellulitis.

Results: There were 84,052 patients who underwent strabismus surgery. 38,484 (46%) patients received 1 or more postoperative topical antibiotics. About 70% of the patients were White and 10% Black. There was a slight female preponderance (51%). Endophthalmitis developed in 16 patients (0.019%), orbital cellulitis in 24 patients (0.029%) and preseptal cellulitis in 55 patients (0.065%). There was no difference in the rates of endophthalmitis, orbital, and preseptal cellulitis between the groups (p values 0.855, 0.684, 0.925 respectively).

Conclusions: The prescription of prophylactic topical antibiotics did not decrease rates of surgical site infections following strabismus surgery. Administering postoperative topical antibiotics can be distressing to children, costly, and may contribute to antimicrobial resistance. Given no clear advantage and potential disadvantages, the use of postoperative topical antibiotics following strabismus surgery may not be beneficial.