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Assessing the accuracy of intracameral antibiotic preparation for use in cataract surgery

Lockington, D. and Flowers, H. and Young, D. and Yorston, D. (2010) Assessing the accuracy of intracameral antibiotic preparation for use in cataract surgery. Journal of Cataract and Refractive Surgery, 36 (2). pp. 286-289. ISSN 0886-3350

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Abstract

PURPOSE: To evaluate 2 local dilution protocols to assess the accuracy and variability of intracameral antibiotic dosage in cataract surgery. SETTING: Tennent Institute of Ophthalmology, Glasgow, United Kingdom. METHODS: Ten ophthalmic operating room nurses from 2 local hospitals participated. Oven-dried analytical grade potassium chloride (KCl) was used as a surrogate for cefuroxime. Solutions intended for intracameral use (1.0 mg in 0.1 mL) were prepared according to the 2 protocols. Twenty samples were obtained for each protocol. Ten analytical chemists also performed both dilutions. Concentrations of KCl in each 0.1 mL sample were analyzed by flame photometry. RESULTS: Thirty samples were obtained for each protocol. The median dose after dilution was 1.17 mg (range 0.62 to 1.77 mg) for protocol 1 and 2.05 mg (range 0.52 to 7.25 mg) for protocol 2. The median was significantly higher for protocol 2 (P < .001). There was also greater variability with protocol 2. CONCLUSIONS: This study shows that the mathematical accuracy of a dilution protocol does not ensure dosage accuracy in the clinical scenario. Inadequate mixing in a 1.0 mL syringe was probably responsible for the inaccuracy of protocol 2, indicating that small-volume syringes should not be used for mixing. However, protocol 1 had an acceptable range of variability. Replication of this study could evaluate other protocols and address concerns regarding the accuracy of intracameral antibiotic preparations.