**8. Post-operative antibiotic prophylaxis**

Over the past several decades, sub-conjunctival antibiotics injection has been advocated as a prophylaxis against infection after most of the intraocular surgeries. [1-3] At the time of subconjunctival antibiotic injection, corticosteroids are frequently used as adjunctive treatment to reduce the inflammatory response due to infection that might help to reduce secondary damage. No study, however has proven that this method has any prophylactic effect on the prevention of endophthalmitis. [1] A retrospective report found one case of endophthalmitis after 8856 surgeries using sub-conjunctival antibiotics and 9 cases of endophthalmitis fol‐ lowing 5030 surgeries without having sub-conjunctival injections. [48] Sub-conjunctival anti‐ biotics may temporarily provide therapeutic levels in the anterior segment but do not penetrate sufficiently into the vitreous cavity, and hence larger retrospective studies did not reveal any additional benefit compared with intra-vitreal antibiotic application.

A careful wound construction with a minimum wound leakage and the placement of su‐ tures when necessary is recommended to prevent incident of any post-operative infection. [19, 43] Optical coherence tomography may show variations in gaping of un-healed wounds and Indian ink may migrate through un-healed wound into the anterior chamber. Experi‐ ence has shown that it may take upto a week before the epithelial surface heals completely to have the wound become water-tight. Therefore, it may be necessary that post-operatively one may consider addition of topical antibiotics drops. Some studies have suggested that sil‐ icone IOLs may have a three times higher risk of developing post-operative endophthalmitis than acrylic IOLs. On the other hand, hydrophilic heparin-coated IOLs have demonstrated their lower adherence for Staphylococcal organisms to the lens surface. [1-3] In order to re‐ duce the risk of infection following clear corneal incisions, the use of topical antibiotic drops for 1-2 weeks after the surgery has been recommended. [49] Usually broad spectrum antibi‐ otics are used to cover the most commonly encountered microorganism. These antibiotics are administered topically 4-6 times daily.
