Unilateral endophthalmitis after simultaneous bilateral cataract surgery

Abstract

We would like to share our experiences with simultaneous bilateral cataract surgery in response to the letter by Khokhar and coauthors.1 As surgeons who perform simultaneous bilateral cataract surgery,2 we agree with the reply by Sharma and Worstmann3 and would like to present 2 advantages of this type of surgery. First, defenders of this type of surgery do not claim that it is appropriate in all patients with bilateral cataract. As Sharma and Worstmann et al. stated,3 simultaneous bilateral cataract surgery could be a good option for patients who understand and accept the benefits and risks and patients who are old, infirm, have psychiatric disorders or inadequate intelligence, or who prefer 1 surgery and postoperative follow-up examinations instead of 2 surgeries. Second, the main concern about simultaneous surgery is the possibility of simultaneous bilateral endophthalmitis. We, as Dr. Bolger,4 do not think that this concern is realistic. Disposable equipment, use of strong antiseptic agents such as povidone–iodine, and small-incision cataract surgery have all decreased the rate of postoperative infection. There are no reports of simultaneous bilateral endophthalmitis after simultaneous bilateral extracapsular cataract extraction or phacoemulsification since simultaneous surgery has been performed (approximately 1985). To our knowledge, there are 4 reports of endophthalmitis since that date and all are uniocular.4,5 We also encountered a fifth case of uniocular endophthalmitis after simultaneous bilateral cataract surgery in September 2000 (after publication of our article). To date, we have performed approximately 140 simultaneous bilateral cataract surgery procedures in adult and pediatric populations and we have had only 1 case of endophthalmitis. That patient, a 72-year-old woman, had bilateral Fuchs' endothelial dystrophy, primary open-angle glaucoma, and cataract. On the second postoperative day, endophthalmitis occurred in the eye that was operated on first. Although we did not notice pathology in the history or examination before surgery, after the endophthalmitis, the patient mentioned tearing attacks in this eye for some years with the diagnosis of chronic dacryocystitis. We applied intravitreal antibiotic injections twice along with frequent antibiotic drops, but the final visual acuity was hand motions. There was no irritation in the fellow eye. We think that this case supports the safety of simultaneous bilateral cataract surgery. Hüseyin Bayramlar MD Uğur C. Keskin MD aMalatya, Turkey