Abstract
BackgroundAcute endophthalmitis is one of the most serious complications of cataract surgery and often results in severe visual impairment. Several risk factors for acute postoperative endophthalmitis (POE) following cataract surgery have been reported but the level of evidence and strength of association is varied. The purpose of this study was to critically appraise published reports on and to summarize clinical risk factors associated with acute POE which could be easily assessed by ophthalmologists for the introduction and implementation of preventive measure.MethodsA systematic review and meta-analysis of observational studies was performed. Six databases were searched with no limits on the year or language of publication. Study-specific odds ratios (Ors) or relative risk (RR) of each risk factor were pooled using a random effect model.ResultsA total of 6 686 169 participants with 8 963 endophthalmitis in 42 studies were analyzed. Of the nine risk factors identified in our systematic review and meta-analysis, extra- or intracapsular cataract extraction, a clear corneal incision, without intracameral cefazolin (1 mg in 0.1 ml solution), without intracameral cefuroxime (1 mg in 0.1 ml solution), post capsular rupture, silicone intraocular lenses and intraoperative complications were found strongly associated with acute endophthalmitis. Other significant factors with a lower strength of association (risk estimates generally 1.5 or less) were male gender and old age (85 years and older).ConclusionsOur study provides summary data on the risk factors for acute POE. Identifying patients at high risk of this sight-threatening eye disease is important from both the public health and clinical perspectives as this would facilitate detection of disease before the onset of irreversible visual loss enabling earlier intervention.
Highlights
The World Health Organization’s Prevention of Blindness and Visual Impairment makes the global estimate that the number of people of all ages visually impaired is estimated to be 285 million, of whom 39 million are blind in 2010
We followed the criteria used in the Endophthalmitis Vitrectomy Study (EVS) [29], not excluding any presumed acute endophthalmitis after cataract surgery, because it would allow for the inclusion of more studies in order to generate more power for analyzing this relatively rare complication
Funnel plots were reviewed for each risk factors and no evidence of publication bias was observed
Summary
The World Health Organization’s Prevention of Blindness and Visual Impairment makes the global estimate that the number of people of all ages visually impaired is estimated to be 285 million, of whom 39 million are blind in 2010. Cataract surgery is highly effective and relatively safe, owing to the enormous numbers, even uncommon surgical complications could potentially harm many patients. Endophthalmitis is one of the most serious complications of cataract surgery and often results in severe visual impairment [2]. Acute endophthalmitis is one of the most serious complications of cataract surgery and often results in severe visual impairment. Several risk factors for acute postoperative endophthalmitis (POE) following cataract surgery have been reported but the level of evidence and strength of association is varied. The purpose of this study was to critically appraise published reports on and to summarize clinical risk factors associated with acute POE which could be assessed by ophthalmologists for the introduction and implementation of preventive measure
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