Introduction: Cataract surgery is one of the most commonly performed procedures in human medicine. Although the risk of postoperative inflammatory complications is low, their consequences can be devastating. The current global standard for preventing such complications is intracameral administration of antibiotics, while the role of prophylactic topical antibiotics in uncomplicated cases remains controversial.
Aim: The aim of this paper is to evaluate the available evidence regarding the effectiveness of topical antibiotic prophylaxis in uncomplicated cataract surgery in the era of routine intracameral antibiotic use.
Methods: The authors conducted a review of the recent literature and major clinical studies (ESCRS, Kaiser Permanente, Cochrane), comparing the incidence of endophthalmitis with the use of intracameral antibiotics alone versus in combination with postoperative topical antibiotics.
Results: Intracameral antibiotic administration significantly reduces the risk of endophthalmitis (up to 4.9-fold reduction according to the ESCRS study). There is no evidence that subsequent use of topical antibiotic drops further reduces the risk of infection in uncomplicated cases. Moreover, repeated topical antibiotic use increases the risk of patients developing antibiotic resistance and poses a significant financial and logistical burden.
Conclusion: In uncomplicated cataract surgery, postoperative topical antibiotics are not indicated when intracameral prophylaxis is applied. Their use should be reserved for high-risk cases only (e.g. following complicated surgery, in immunocompromised patients, or in the presence of chronic blepharitis).