Incidence Of Postoperative Endophthalmitis Research Articles

Twenty years of endophthalmitis: Incidence, aetiology and clinical outcome.

To review the incidence, aetiology and outcomes of endophthalmitis during a 20-year period in a Norwegian university hospital. Single-centre retrospective review. Medical records of all patients admitted to Stavanger University Hospital with suspected endophthalmitis between January 1999 and December 2018 were reviewed. We identified 84 eyes of 81 patients. Postoperative endophthalmitis (PE) was seen in 64 eyes (76%), endogenous endophthalmitis in thirteen eyes (15%), trauma in four eyes (5%) and three eyes (4%) had keratitis-associated endophthalmitis. Administration of intravitreal injections (IVI) was the most common cause (30%), followed by cataract surgery (CS) (21%). Of 40238 IVI, 23 PE cases were identified (incidence, 0.057%; 95% confidence interval [CI] 0.036-0.086%). Of 39697 CS, 12 PE cases were identified (incidence, 0.030%; 95%CI 0.016-0.053%). After introduction of intracameral cefuroxime PE incidence after CS decreased from 0.10% in 1999-2003 to 0.015% in 2004-2018 (p=0.003). Eighty-four per cent of organisms were Gram-positive. Coagulase-negative staphylococci accounted for 54% of culture-proven cases, and 89% of post-IVI culture-proven cases. Thirty eyes (36%) either regained their previous vision or lost ≤1 Early Treatment Diabetic Retinopathy Study line. One third of endophthalmitis cases had a favourable visual outcome of logMAR 0.2 or better. PE after IVI occurred in 1 in 1750 procedures, and was the most common cause of PE. The incidence of PE after CS has decreased >sixfold since 2003, to 1 in 6700 surgeries. A high proportion of low-virulence bacterial species may have contributed to the favourable visual outcome.

Postoperative Complications in Medicare Beneficiaries Following Endothelial Keratoplasty Surgery

To determine national-level incidence rates of major postoperative complications following endothelial keratoplasty (EK) procedures and to stratify these rates based on EK indications over an 8-year period using Medicare claims data. Retrospective, cohort study. Setting: population-based; study population: Medicare beneficiaries aged ≥65 years who underwent EK procedures; main outcome measurements: 1) occurrence of major postoperative complications (i.e., endophthalmitis, choroidal hemorrhage, infectious keratitis, cystoid macular edema [CME], retinal detachment [RD], or RD surgery) following EK surgery; 2) time-to-event analysis for glaucoma surgery; and 3) occurrence of graft complications. A total of 94,829 EK procedures (n= 71,040 unique patients) were included in the analysis. Of the total, 29% of patients had pre-existing glaucoma. The overall 90-day cumulative incidence of postoperative endophthalmitis and choroidal hemorrhage following EK was 0.03% and 0.05%, respectively. The overall 1-year cumulative rates of RD or RD surgery, infectious keratitis, and CME were 1.0%, 0.8%, and 4.1%, respectively. Approximately 7.6%, 12.2%, and 13.8% of all eyes in this study needed glaucoma surgery at 1-, 5-, and 8-years of follow-up, respectively. The probability of glaucoma surgery among patients with pre-existing glaucoma was 29% vs. 8% among those without pre-existing glaucoma at 8 years. The cumulative probabilities of developing any graft complications were 13%, 23.2%, and 27.1% at 1, 5, and 8 years, respectively, of follow-up. On average, patients undergoing EK procedures for a prior failed graft had the highest rate of complications, whereas those with Fuchs' corneal endothelial dystrophy had the lowest. The incidence of major postoperative complications including endophthalmitis, retinal detachment, and choroidal hemorrhage following EK procedures is low. A high proportion of eyes undergoing EK eventually require glaucoma surgery and experience graft-related complications. Postoperative outcomes are typically worse for patients undergoing EK for prior failed grafts than for those undergoing EK for Fuchs' corneal endothelial dystrophy.

Incidence, Prophylaxis and Visual Outcomes of Acute Postoperative Endophthalmitis after Cataract Surgery: A Multicenter Retrospective Analysis in Northern China

Background: Cataract is the most prevalent cause of blindness worldwide, and millions of cataract surgeries are performed in China every year. Postoperative endophthalmitis (POE), a devastating infectious complication of cataract surgery, often results in extremely poor visual prognosis, even blindness. We investigated the incidence of acute POE after cataract surgery in Northern China from 2012 to 2018, evaluated the effectiveness of perioperative infection prophylaxis and analyzed the potential prognosis factor for the final visual outcome of POE patients. Methods: The study was designed as a retrospective multicenter research, with seven hospitals in Northern China enrolled. The diagnosis of acute-onset POE was mainly made on the basis of clinical manifestations within six weeks after initial surgery. By reviewing electronic medical system, the number of cataract surgeries and acute POE cases were recorded to estimate the overall incidence and incidences among different years and hospitals. Perioperative measures for preventing infection in different hospitals were collected to evaluate their effectiveness in reducing the risk of developing POE. The correlations between final visual acuity and potential factors including basal information and clinical characteristics were examined to determine the predictive factors for the visual prognosis. Findings: Of 72,255 cataract surgeries performed during seven years in the seven hospitals, 19 cases developed acute POE, yielding an incidence of 0·026% (95%CI 0·015%, 0·038%). The occurrence rate of acute POE significantly declined year by year over the period (p=0·021), from 0·056% in 2012 to 0·007% in 2018. The incidence of acute POE significantly decreased in Hospital-D after the application of 0·5% povidone-iodine (PVP-I) for conjunctival washing (p =0·003). Two hospitals adopting tobramycin in the irrigation solution achieved a significant lower incidence than the other hospitals (p=0·044). At the onset of endophthalmitis, the best BCVA presented was 20/70 and only four patients (21·1%) achieved BCVA better than counting fingers (CF). The positive rate of pathogen culture was just 17·6% (3/19) in our study, with Staphylococcus hominis isolated in two cases and Streptococcus cultured in one case. Patients with presenting BCVA of CF or better was more likely to achieve a better final visual outcome than those with worse presenting BCVA (p=0·003). Interpretation: In the past seven years, the incidence of POE after cataract surgery declined annually in Northern China, but there are still broad gaps among different level hospitals which much more effort should be made to eliminate. Due to the regional variation in the POE incidence, it is essential for cataract surgeons to figure out the recent incidence and changing tendency of POE in their own regions, thereby being sensitive and keeping alerting to its occurrence. Prophylactic use of 0·5% PVP-I and tobramycin in irrigation solution should be applied to prevent POE after cataract surgery, and presenting BCVA could be regarded as a prognosis factor for the final visual outcome. Funding Statement: National Science and Technology Major Project (2018ZX10101004) Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study was designed as a retrospective multicenter research. It was approved by the Ethical Committees of all the included hospitals and conformed to the tenets of the Declaration of Helsinki.

A comparative study of post-operative endophthalmitis between immediate versus delayed management of eventful cataract extraction.

Objective:To compare the incidence of postoperative endophthalmitis after eventful cataract surgery i.e. posterior capsular rupture, in patients managed with anterior vitrectomy and intra ocular lens implantation intraoperatively to patients managed with anterior vitrectomy and intraocular lens implantation two weeks after the posterior capsule rupture.Methods:This comparative study was conducted at Layton Rahamatullah Benevolent Trust, Free Base Eye Hospital Korangi, Karachi from February 2017 to December 2018. The study included two groups, group A had patients with intra ocular lens implanted after posterior capsule rupture intraoperatively, while Group B had patients with intra ocular lens implanted after two weeks of initial surgery. Incidence rate of post-operative endophthalmitis was compared between two groups, which happened within six weeks after intra ocular lens implantation surgery.Results:Total number of cataract surgeries that were performed during the study was 37,969. Incidence of postoperative endophthalmitis was 0.0019%. The study enrolled patients with complicated cataract surgeries that were 3508 (0.09%). Out of which incidence of post-operative endophthalmitis that occurred in group A was 0.007% and group B was 0.002%. (p value <0.05). The study also found that complicated extracapsular cataract extraction with intraocular lens implantation had more cases of endophthalmitis compared to phacoemulsification with intraocular lens.Conclusion:This study showed that management of posterior capsular rupture through anterior vitrectomy and secondary intraocular lens implantation after two weeks has less chances of postoperative endophthalmitis.

Prophylaxis of Postoperative Acute Endopthalmitis Following Cataract Surgery

Background: Postoperative Endophthalmitis is a rare complication after intraocular surgeries. However, it remains one of the most devastating complications following cataract surgery because of its poor prognosis. We describe the effects of antibiotic prophylaxis on the incidence of postoperative endophthalmitis after cataract surgery, particularly phacoemulsification. Aim of the work: To identify risk factors of acute endophthalmitis and describe the effects of antibiotic prophylaxis on the incidence of postoperative endophthalmitis after phacoemulsification surgery. Methods: A prospective randomized cataract surgery study recruited 300 patients; 150 patients who received just intracameral vigamox at the end of surgery without topical antibiotics before surgery and 150 patients who received both intracameral vigamoxas well as topical perioperative vigamox which either just half an hour before surgery or three days preceding surgery. We took a conjunctival swab before and after vigamox administration in order to detect the type of conjunctival flora in the Libyan population as well as the effect of the vigamox on the conjunctival flora by using Phoenix-BD machine. In total we collected 166 specimens (83 patients). Results: In all groups no acute post-operative endophthalmitis was reported. Conclusions: The study was based on intracameral Moxifloxacin at the end of surgery with and without topical antibiotics drops administration. The incidence of postcataract endophthalmitis was not reported in our study after using intracameral antibiotics, as it seems to be effective in preventing endophthalmitis after cataract surgery.

Seasonal variation in acute post-cataract surgery endophthalmitis incidences in South Korea

Previous studies have reported conflicting results on the influence of seasons on post-cataract surgery endophthalmitis incidences. This study aimed to investigate the seasonality associated with the incidence of postoperative endophthalmitis, and to evaluate its association with climate variables in South Korea. South Korea. Retrospective cohort study. The postoperative endophthalmitis incidences were identified using the Health Insurance Review and Assessment Service claim data from July 2014 to June 2017. The monthly climate data were obtained from the Korea Meteorological Administration. The incidences of endophthalmitis were analyzed by the month of the year, and by the season. The association between postoperative endophthalmitis and the climatic variables, including mean temperature, relative humidity, precipitation, and hours of sunshine, was investigated. The incidences were the highest in July, and they were the most prevalent during the summer months, although fewer cataract surgeries were performed in the summer months than during the rest of the year. The postoperative endophthalmitis incidences tended to increase with increasing relative humidity and increasing precipitation. The incidences of post-cataract surgery endophthalmitis peaked during the hot and humid months. Understanding the seasonal and climatic influences on postoperative infection might help in risk stratification and outcome improvisation after the cataract surgery is performed.

Incidence of acute postoperative endophthalmitis following macular surgery in France between 2006 and 2016.

To report the incidence of acute postoperative endophthalmitis (POE) after macular surgery in France between 2006 and 2016 and to identify associated factors. This retrospective database study included all hospital discharge records involving a surgical procedure for an epiretinal membrane or a macular hole in France from January 2006 to October 2016. Acute POE was identified by two codes in the tenth edition of the International Classification of Diseases within 42days of a macular surgical procedure in the French national administrative database. In France, 152034 macular surgical procedures for epiretinal membranes or macular holes were recorded from 1 January 2006 to 31 October 2016. Suspected acute POE was reported in 381 cases. The incidence of POE was 0.25% overall, 0.30% for epiretinal membrane surgery and 0.14% for macular hole surgery. In multivariable Poisson regression analysis, epiretinal membrane surgery was associated with POE [incidence rate ratio (IRR), 2.24; 95% CI, 1.62-3.11; p<0.001]. For epiretinal membrane surgery, the 2010-2011 period was significantly associated with a higher risk of POE (IRR, 1.66; 95% CI, 1.13-2.42; p=0.03). The incidence of POE after macular surgery was 0.25% overall in France between 2006 and 2016 and twice higher for epiretinal membrane surgery than for macular hole surgery. For epiretinal surgery only, the incidence of POE was higher in 2010-2011 (period of the switch to transconjunctival vitrectomy) than in the rest of the study period.

Paediatric endophthalmitis: a UK retrospective study.

Paediatric endophthalmitis is a severe but rare complication of intraocular surgery, penetrating trauma and far less commonly extra-ocular surgery or endogenous origin. We set out to establish the incidence and risk factors of exogenous endophthalmitis in children, and to develop an evidence-based protocol that can be used for treatment of suspected exogenous endophthalmitis in children. Microbiology reports and operation numbers were obtained from two large tertiary referral hospitals sharing 24-h paediatric ophthalmology cover for the period January 2009-December 2016. All cases of aqueous and/or vitreous tap performed on children aged ≤18 years were identified and case notes reviewed for complete information on each case. Sixteen cases were eligible for inclusion as 'postoperative endophthalmitis': complete data was found on 13 cases. The incidence of postoperative endophthalmitis was 0.17% over 7 years. The mean age of presentation was 5.5 years (range from 7 months to 16 years and 9 months), from 3 days-78 months post operatively. In all, 11/13 had at least one glaucoma procedure. Microbiology results showed growth in 8/13. Most isolates were Gram-positive bacteria but Gram-negatives were also isolated and in one case Candida from a conjunctival swab. The antibiotic regime varied depending on age, organism identified and sensitivities. In all, 9/13 had hand movement or worse vision after treatment. Paediatric endophthalmitis may present to any paediatric/general ophthalmologist. It is a rare but devastating condition with poor visual prognosis, requiring prompt recognition and aggressive management. Previous glaucoma surgery is a long-term risk factor in our local paediatric population. Based on our study, an evidence-based protocol for management is proposed in order to improve outcomes.

Incidence and Characteristics of Endophthalmitis after Cataract Surgery in Poland, during 2010-2015.

Background: The assessment of the incidence and characteristic of acute and chronic postoperative endophthalmitis (POE) after cataract surgery in Poland during 2010–2015. Patients and methods: All hospitalizations of patients, in the National Database of Hospitalizations, who underwent cataract surgery alone or in combined procedures in Poland between January 2010 and December 2015, with a billing code of endophthalmitis, were selected. Acute endophthalmitis was identified if symptoms occurred within 1–42 days from the cataract surgery and chronic endophthalmitis if symptoms occurred ≥43 days after cataract surgery, respectively. Results: In total, 1331 cases of POE after 1,218,777 cataract extractions were identified. The overall incidence of POE decreased from 0.125% in 2010 to 0.066% in 2015. In multiple logistic regression analyses, increasing age was significantly associated with acute POE, while type II diabetes mellitus, extracapsular cataract extraction, and one-day surgery were significantly associated with chronic POE. The combined cataract surgery and male sex were significant risk factors for both acute and chronic POE. A total of 62.51% of all eyes affected by POE received antibiotic treatment and 37.49% had vitrectomy treatment. Conclusions: During the study period, the total incidence of postoperative endophthalmitis after cataract surgery decreased significantly.

The Malaysian cataract surgery registry: incidence and risk factors of postoperative infectious endophthalmitis over a 7-year period.

To report the incidence, risk factors and visual outcomes for postoperative endophthalmitis (POE) based on 7-year data from the Malaysian Ministry of Health Cataract Surgery Registry (MOH CSR). Data was collected from the web-based MOH CSR. All consecutive cataract surgery patients from 1st June 2008 to 31st December 2014 were identified. Exclusion criteria were traumatic cataract or previous ocular surgery. Demographic data, ocular co-morbidities, intraoperative details and postoperative visual acuity (VA) at final ophthalmological follow-up were noted. All eyes were taken for analysis. Subjects with POE were compared against subjects with no POE for risk factor assessment using multiple logistic regressions. A total of 163 503 subjects were screened. The incidence of POE was 0.08% (131/163 503). Demographic POE risk factors included male gender (OR: 2.121, 95%CI: 1.464-3.015) and renal disease (OR: 2.867, 95%CI: 1.503-5.467). POE risk increased with secondary causes of cataract (OR: 3.562, 95%CI: 1.740-7.288), uveitis (OR: 11.663, 95%CI: 4.292-31.693) and diabetic retinopathy (OR: 1.720, 95%CI: 1.078-2.744). Intraoperative factors reducing POE were shorter surgical time (OR: 2.114, 95%CI: 1.473-3.032), topical or intracameral anaesthesia (OR: 1.823, 95%CI: 1.278-2.602), posterior chamber intraocular lens (PCIOL; OR: 4.992, 95%CI: 2.689-9.266) and foldable IOL (OR: 2.276, 95%CI: 1.498-3.457). POE risk increased with posterior capsule rupture (OR: 3.773, 95%CI: 1.915-7.432) and vitreous loss (OR: 3.907, 95%CI: 1.720-8.873). Postoperative VA of 6/12 or better was achieved in 15.27% (20/131) subjects with POE. This study concurs with other studies regarding POE risk factors. Further strengthening of MOH CSR data collection process will enable deeper analysis and optimization of POE treatment.

Comparative analysis of the safety and efficacy of intracameral cefuroxime, moxifloxacin and vancomycin at the end of cataract surgery: a meta-analysis

BackgroundCurrent practice methods are unclear as to the most safe and effective prophylactic pharmacotherapy and method of delivery to reduce postoperative endophthalmitis occurrence.MethodsA systematic review and meta-analysis using Meta-analysis of...

A Novel Biomimetic Nanosponge Protects the Retina from the Enterococcus faecalis Cytolysin.

Intraocular infections are a potentially blinding complication of common ocular surgeries and traumatic eye injuries. Bacterial toxins synthesized in the eye can damage intraocular tissue, often resulting in poor visual outcomes. Enteroccocus faecalis causes blinding infections and is responsible for 8 to 17% of postoperative endophthalmitis cases. These infections are increasingly difficult to treat due to the emergence of multidrug-resistant strains. Virulent E.faecalis isolates secrete a pore-forming bicomponent cytolysin that contributes to retinal tissue damage during endophthalmitis. We hypothesized that a biomimetic nanosponge, which mimics erythrocytes, might adsorb subunits of the cytolysin and reduce retinal damage, protecting vision. To test the efficacy of nanosponges in neutralizing the cytolysin in vitro, hemoglobin release assays were performed on culture supernatants from cytolysin-producing E.faecalis with and without preincubation with nanosponges. Treatment with nanosponges for 30min reduced hemolytic activity by ~70%. To determine whether nanosponges could neutralize the cytolysin in vivo, electroretinography was performed on mice 24h after intravitreal injection with cytolysin-containing supernatants treated with nanosponges. Pretreatment of cytolysin-containing supernatants with nanosponges increased the A-wave retention from 12.2% to 65.5% and increased the B-wave retention from 21.0% to 77.0%. Histology revealed that in nanosponge-treated eyes, retinas remained intact and attached, with little to no damage. Rabbit nanosponges were also nontoxic and noninflammatory when injected into mouse eyes. In an experimental murine model of E.faecalis endophthalmitis, injection of nanosponges into the vitreous 6h after infection with a wild-type cytolysin-producing strain increased A-wave retention from 5.9% to 31% and increased B-wave retention from 12.6% to 27.8%. Together, these results demonstrated that biomimetic nanosponges neutralized cytolysin activity and protected the retinas from damage. These results suggest that this novel strategy might also protect eyes from the activities of pore-forming toxins of other virulent ocular bacterial pathogens. IMPORTANCE Endophthalmitis is a serious, potentially blinding infection that can result in vision loss, leaving a patient with only the ability to count fingers, or it may require enucleation of the globe. The incidence of postoperative endophthalmitis has markedly increased over the past 2 decades, paralleling the rise in ocular surgeries and intravitreal therapies. E.faecalis is a leading cause of infection following ocular procedures, and such infections are increasingly difficult to treat due to multidrug resistance. Cytolysin is the primary virulence factor responsible for retinal tissue damage in E.faecalis eye infections. Treatment of these infections with antibiotics alone does not impede ocular damage and loss of visual function. Pore-forming toxins (PFTs) have been established as major virulence factors in endophthalmitis caused by several bacterial species. These facts establish a critical need for a novel therapy to neutralize bacterial PFTs such as cytolysin. Here, we demonstrate that biomimetic nanosponges neutralize cytolysin, protect the retina, preserve vision, and may provide an adjunct detoxification therapy for bacterial infections.

Safety of Fixed drug Combination in Post –Operative Cataract Patients, at Tertiary Care Centre – In South India

Cataract is any opacification in lens or its capsule, which accounts for about 50% of treatable blindness worldwide. The prevalence of cataract in India is about 62.6%. The incidence of post operative endophthalmitis ranges from 0.05% - 0.14% and so the use of post-operative antibiotics and steroids is necessary to control infection and prevent inflammation. Fixed drug combinations not only cut the cost but also the dosage and improve the compliance of patients in the immediate post operative period. In this regard, the present study was conducted with the aim of studying the efficacy of using fixed drug combination (Difluprednate and Moxifloxacin) in reducing ocular inflammation and pain in post-operative patients undergoing cataract surgery. Study design: Prospective interventional study, in which 749 eyes underwent SICS with IOL. All of them were treated with Difluprednate and Moxifloxacin, combination eye drops postoperatively 4 times a day, and reviewed on day 1, 5 and once in two weeks up to 6 weeks. Out of 749 eyes, 730 were normal, 10 eyes had minimal raise in IOP in the range of 21 mmHg-31mmHg (considering 21mmHg as baseline) which decreased without any intervention within 3 weeks and only 9 eyes had raise in IOP of more than 31mmHg, which did not decrease in spite of discontinuing the drops and needed anti-glaucoma treatment. Our study clearly shows that fixed drug combination of antibiotic and steroid does not cause raised IOP in about 97% of cases of SICS in the post-operative period and also improves the compliance of the patients.

Efficacy and cost-effectiveness of intracameral vancomycin in reducing postoperative endophthalmitis incidence in Australia.

Endophthalmitis is a rare but devastating postoperative complication of cataract surgery. We aimed to describe the incidence of acute postoperative endophthalmitis in an Australian population over a 14-year period. This was a retrospective longitudinal cohort study performed at Westmead Hospital, a major tertiary hospital in Sydney, Australia. Patients who had acute postoperative endophthalmitis within 6 weeks of their cataract surgery at Westmead Hospital were included. Endophthalmitis cases from 2000 to 2014 were identified from computerized diagnostic coding. These were cross-referenced with the cataract surgery list over this time period. The routine use of intracameral vancomycin at the end of cataract surgery was introduced in Westmead Hospital in 2004. We quantified the incidence of acute postoperative endophthalmitis pre and post the routine use of intracameral vancomycin. A total of 14 805 cataract cases were performed at Westmead Hospital from 2000 to 2014. Seventeen cases of endophthalmitis were within 6 weeks post cataract surgery performed at Westmead Hospital. In the period 2000 to 2003, the incidence of postoperative endophthalmitis was 0.43% (11/2539). From 2004 to 2014, there was a dramatic decrease in the incidence of postoperative endophthalmitis to 0.049% (6/12 266, P < 0.0001). There has been a nine-fold reduction in the rate of acute postoperative endophthalmitis with the use of intracameral vancomycin in cataract surgery. Post-cataract surgery endophthalmitis is now a relatively rare cause of endophthalmitis in this Australian population. Our study supports the routine use of intracameral vancomycin as postoperative endophthalmitis prophylaxis.

Effectiveness and Safety of an Intracameral Injection of Cefuroxime for the Prevention of Endophthalmitis After Cataract Surgery With or Without Perioperative Capsular Rupture.

Postoperative endophthalmitis (POE) often results in severe visual impairment. In clinical studies, an intracameral cefuroxime injection at the end of surgery was found to be effective at reducing the incidence of POE. Two important issues are the retinal safety of cefuroxime and its use for patients with perioperative capsular rupture where the risk of POE is dramatically increased. To assess the effectiveness and retinal safety of an intracameral injection of cefuroxime sodium for the prevention of POE and its possible use in cases of a perioperative capsular rupture of the lens. Population-based cohort study of patients 40 years of age or older who underwent cataract surgery at 1 of 1546 French health care facilities, public or private, and whose medical records were obtained from the national administrative database. Data analyses were performed between March and November 2015. The effectiveness and safety of the prophylactic injection of cefuroxime as measured by the incidence of POE and cystoid macular edema. From January 2010 to October 2014, a total of 3 351 401 eyes of 2 434 008 patients 40 years of age or older (58.9% were women, and the mean [SD] age was 73.9 [9.5] years) underwent cataract surgery; 1941 patients (0.08%) developed POE during the 6 weeks after cataract surgery. The incidence of POE after cataract surgery decreased over the course of the study (0.11%, 0.09%, 0.08%, 0.06%, and 0.05% in 2010, 2011, 2012, 2013, and 2014, respectively [P = .001 for trend]) as the use of cefuroxime prophylactic injections increased (11.1%, 14.4%, 32.8%, 64.8%, and 79.1% in 2010, 2011, 2012, 2013, and 2014, respectively [P = .001 for trend]). After multivariate adjustment, the risk of POE was reduced with the use of cefuroxime (odds ratio, 0.61 [95% CI, 0.56-0.68]). The retinal safety of an injection of cefuroxime, which was assessed by multiadjusted odds of retinal cystoid macular edema, was not increased for patients receiving cefuroxime injections (odds ratio, 0.86 [95% CI, 0.71-1.05]). For patients with a perioperative capsular rupture of the lens (the major risk factor for POE), the incidence of POE was lower for those who received an injection of cefuroxime than for those who did not (0.37% vs 0.51%, respectively [P = .001]), whereas an increased risk of cystoid macular edema was not identified for those who received or did not receive an injection of cefuroxime (5.6% vs 7.3%, respectively [P = .12]). These data suggest that, in routine practice, the intracameral injection of cefuroxime at the conclusion of cataract surgery is associated with a lower risk of POE and is safe for patients with or without a perioperative capsular rupture. While these data might be used to support the consideration of its routine use to prevent POE, in the absence of a randomized clinical trial, they cannot prove a direct cause-and-effect relationship between the injection of cefuroxime and POE.

Efectividad y costos de la cefuroxima intracameral en la profilaxis de la endoftalmitis poscirugía de catarata

AimTo evaluate the effectiveness and cost of intracameral cefuroxime for postoperative endophthalmitis (PE) prophylaxis in Holguín's Ophthalmological Center. MethodsRetrospective consecutive cohort study including all patients undergoing cataract surgery in Holguín's Ophthalmological Center between January 2008 and June 2015. Patients were classified in 2 groups: Group 1 operated on between January 2008 and June 2010, with the use of subconjunctival gentamycin at the end of surgery and group 2 operated on between July 2010 and June 2015, in whom a 1mg/0.1 bolus of intracameral cefuroxime was instilled. The rates of PE were determined per year and groups of study as the effectiveness and cost of the 2 prophylactic methods. ResultsAt Holguín's Ophthalmological Center there were 27 reported cases of PE from 2008 to June 2015 from a total of 11,117 cataract procedures. The highest incidence was reached in 2009 with a rate of 0.83%. The mean incidence rate in group 1 was 0.85%, while in group 2 de mean incidence was 0.07%. Introduction of intracameral cefuroxime represented a significant reduction in the incidence of PE (P<.005). The relative risk for endophthalmitis in group 1 against group 2 was 13.3 times bigger. The use of cefuroxime resulted less expensive. Cost- effectiveness relationship for this drug (0.0027) was 3 times better than gentamicin's (0.0075). ConclusionsAdministration of intracameral cefuroxime resulted more effective and less expensive in preventing endophthalmitis after cataract surgery.

A Review of Antibiotic Prophylaxis for Post-operative Endophthalmitis

The purpose of this review is to summarise all available evidence regarding antibiotic prophylaxis for post cataract surgery endophthalmitis as some prophylactic measures add significantly to the cost of surgery, are routinely used and yet their benefit to cataract patients has not been proven. Use of Povidone Iodine before starting the surgery is one of the most effective means of reducing the incidence of postoperative endophthalmitis. Intracameral cefuroxime is another important measure advocated by many studies. Intracameral moxifloxacin may be considered as an alternative to cefuroxime. Although pre and post-operative systemic or topical antibiotics, subconjunctival antibiotics and antibiotics in the irrigating solution have not been proven to decrease post-operative endophthalmitis, they have not been shown to be detrimental and hence surgeons may consider their use according to personal preferences and a costbenefit analysis of their healthcare system.

The Incidence of Postoperative Endophthalmitis Before and After a Revised Preoperative Surgical Site Preparation Protocol.

To compare the incidence of postoperative endophthalmitis before and after the implementation of a preoperative surgical site preparation protocol for cataract surgery. Retrospective cohort study. Records of patients with postoperative endophthalmitis between January 2006 and August 2013 were reviewed. A revised protocol implemented after January 2009 included the addition of preoperative 0.3% topical tobramycin, 10% povidone-iodine for cleansing, and using a disposable sterile drape. The incidence, microbiological profile, and outcomes of these cases were analyzed. The incidence of preprotocol endophthalmitis was significantly higher than in the postprotocol period (P = 0.018). More patients in the preprotocol group grew Pseudomonas aeruginosa and Streptococcus pneumoniae as compared with those in the postprotocol group (P = 0.014). A smaller number of patients attained a poor visual outcome after the implementation of the revised protocol (P = 0.035). In our study, the addition of antibiotic eye drops before cataract surgery and perioperative cleansing with 10% povidone-iodine were effective means to reduce the incidence of postoperative endophthalmitis.

An 8-year retrospective study of cataract surgery and postoperative endophthalmitis: injectable intraocular lenses may reduce the incidence of postoperative endophthalmitis

Background/aimsPostoperative endophthalmitis (POE) is a rare but potentially devastating complication of modern cataract surgery. We examine whether the use of injectable intraocular lenses (IOLs) is associated with a lower rate...

The Safety and Efficacy of Routine Administration of Intracameral Vancomycin during Cataract Surgery.

Purpose. To evaluate the safety and efficacy of intracameral vancomycin during cataract surgery using a standardized dosage and delivery technique. Methods. The charts of 20,719 consecutive eyes that underwent phacoemulsification with intraocular lens implantation in a single ambulatory surgery center were retrospectively reviewed over a 5-year period. Results. The first 11,333 consecutive cases did not receive intracameral vancomycin, whereas the next 9,386 consecutive cases all received intracameral vancomycin. There were no significant differences in the baseline characteristics between the cohort of subjects who received intracameral vancomycin and the cohort of subjects that did not. There were a total of 11 subjects (0.97 cases per 1,000) that developed postoperative endophthalmitis in the group that did not receive intracameral vancomycin, whereas there were no cases of postoperative endophthalmitis in the group that received intracameral vancomycin (p = 0.0015). The overall rate of intraoperative and postoperative complications and the final postoperative visual acuities were similar among cohorts. There were no cases of toxic anterior segment syndrome occurring in either group during the study period. Conclusions. Routine administration of intracameral vancomycin during cataract surgery significantly decreased the incidence of postoperative endophthalmitis and was not associated with an increased incidence of postoperative adverse events.