Systematic Review of Clinical Practice Guidelines for Post-Cataract Surgery Endophthalmitis Prophylaxis from 2008-2023

Postoperative endophthalmitis remains a significant concern following cataract surgery with a potential for severe vision loss. Although numerous clinical practice guidelines (CPGs) have been published worldwide, they offer differing recommendations for prophylactic measures. This systematic review aimed to synthesize and evaluate existing guidelines for endophthalmitis prophylaxis after cataract surgery. A comprehensive search including citation and gray literature search was conducted. Authors' contact with peer international ophthalmologists was also employed. Clinical practice guidelines specifically on post-cataract surgery endophthalmitis prophylaxis published between 2008 and 2023 were included in this study. Quality assessment was done using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Twenty-one guidelines were identified, assessed, and extracted. Intracameral antibiotics, instillation of povidone-iodine into the conjunctival sac, and periorbital skin preparation with povidone-iodine were the most commonly endorsed measures, although recommended concentrations, dosages, and contact times varied. Several guidelines did not address ancillary measures, such as face washing, postoperative eye protection or adjunctive topical antibiotics. While core prophylactic strategies were broadly agreed upon, significant differences persisted likely due to disparate local regulations, idiosyncratic practices, and interpretations of the evidence. Careful selection and employment of any procedure should be tailored according to patient characteristics and circumstances.