Objective To investigate the perioperative use of antimicrobial agents in class Ⅰ incisional ophthalmic surgeries in secondary first-class and above medical institutions in Shanghai City, and provide a basis for the rational use of antimicrobial agents in such surgeries. Methods Perioperative antimicrobial prophylaxis (PAP) in patients undergoing class Ⅰ incisional ophthalmic surgery reported by secondary first-class and above hospitals in Shanghai City from 2017 to 2022 was collected retrospectively. The prophylactic use rate, types, rationality of selection, and timing of use of antimicrobial agents were analyzed comprehensively. Results From 2017 to 2022, a total of 54 868 cases of class Ⅰ incisional ophthalmic surgeries were reported from secondary first-class and above hospitals in Shanghai City. The PAP rates in tertiary comprehensive hospitals, tertiary specialty hospitals, tertiary traditional Chinese medicine hospitals, and secondary comprehensive hospitals were 4.72%, 1.79%, 3.22%, and 6.63%, respectively. The overall PAP rate showed a yearly decreasing trend, from 6.39% in 2017 to 2.31% in 2021. Among different types of hospitals, the PAP rate in secondary comprehensive hospitals decreased most significantly, from 12.72% in 2017 to 0.53% in 2022. The main types of prophylactic antimicrobial use were first-, second- and third-generation cephalosporins, and quinolones. The rational selection rates of antimicrobial agents were highest in ter-tiary comprehensive hospitals (17.13%) and lowest in tertiary specialty hospitals (1.08%). The PAP rates in systemic veins 0.5-1 hour before surgery were highest in tertiary specialty hospitals (88.17%) and lowest in tertiary comprehensive hospitals (71.53%). The withdrawal rates of antimicrobial agents within 24 hours after surgery were highest in tertiary traditional Chinese medicine hospitals (80.87%) and lowest in tertiary specialty hospitals (13.26%). Conclusion The PAP for class Ⅰ incisional ophthalmic surgeries in secondary first-class and above medical institutions in Shanghai City still presents certain irrational phenomena in terms of antimicrobial types and administration routes. The administration rate 0.5-1 hour before surgery and withdrawal rate of antimicrobial agents within 24 hours after surgery need to be further improved. Enhanced management is necessary to promote more rational use of antimicrobial agents.