Postoperative endophthalmitis is a rare but potentially visually devastating complication after keratoplasty, ranging from 0.11 to 1.05% [1]. A large number of recently published studies have analysed antibiotic protocols in order to decrease endophthalmitis rates after cataract surgery [2]. In fact, the European Society of Cataract & Refractive Surgeons performed in 2007 the only prospective, multicentre and randomized clinical trial regarding postoperative endophthalmitis after cataract surgery to date [2]. The study showed that intracameral cefuroxime decreases the incidence of postoperative endophthalmitis and its use is being increasingly adopted as routine practice in many countries [2]. However, we have not found in the literature any standardized protocols regarding the prevention of endophthalmitis after keratoplasty.

Postoperative topical antibiotic use is also near universal and retrospective studies suggest that endophthalmitis rates are lower with its use in comparison with those from historical controls [3]. Subconjunctival injections of antibiotics have a long history of widespread international use and two large retrospective studies have identified its use as highly effective in lowering the incidence of postoperative endophthalmitis [3].

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