Risk factors for endophthalmitis after cataract surgery: Predictors for causative organisms and visual outcomes

Abstract

To investigate visual outcome, bacteriology, and time to diagnosis in groups identified as being at risk for endophthalmitis following cataract surgery. Swedish National Cataract Register. A retrospective review of postoperative endophthalmitis and control cases reported from 2002 to 2010. Three identified risk groups for endophthalmitis confirmed in previous multivariate models were organized in such a way that the highest level of significance determined the allocation of cases that belonged to more than one group. Control cases of the entire database were arranged in the same manner. Of the 244 endophthalmitis cases occurring in 692 786 surgeries, 148 did not belong to any risk group, whereas the remaining cases were part of the following groups at risk: nontreatment with intracameral antibiotic (n = 22), communication with vitreous (n = 18), and age 85 years or more (n = 56). Cefuroxime was the intracameral antibiotic used in 99% of treated cases. Cases sustaining a communication with vitreous were found to have the worst visual prognosis. Among causative organisms, Gram-positive bacteria were significantly more frequent in cases with a communication with vitreous, whereas staphylococci and Gram-negative results were more common in patients aged 85 years or more than in nonrisk patients. Limiting the size of the risk groups by giving a prophylactic intracameral antibiotic to every single patient and by intervening earlier in the course of cataract development appear to be first steps in further reducing the endophthalmitis rate. Adjustments of the intracameral regimen may be advantageous in some risk groups. None of the authors has any financial or propriety interest in any material or method mentioned.