Incidence Of Postoperative Endophthalmitis Research Articles

Incidence of postoperative endophthalmitis from 1990 to 2009 using povidone–iodine but no intracameral antibiotics at a single academic institution

To correlate the incidence of postoperative endophthalmitis with changes in the preoperative prophylaxis over a 20-year period. Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany. Retrospective chart review. Patients diagnosed with postoperative endophthalmitis from 1990 to 2009 after intraocular surgery performed at the same institution were included. Because of changes in the preoperative prophylaxis during the study period, 3 groups were formed for data analysis: Period 1 (1990 to 1992), no standardized prophylaxis regimen; period 2 (1993 to 1998), preoperative topical medication, povidone-iodine 10.0% periorbitally, and 1 drop of povidone-iodine 1.0% in the conjunctiva sac; and period 3 (1999 to 2009), similar to period 2 except with irrigation of the conjunctival sac with 10 mL of povidone-iodine 1.0%. The overall rate of postoperative endophthalmitis was 0.113% (77/68,323) for all intraocular surgeries. It decreased significantly from 0.291% (16/5505) in period 1 to 0.170% (33/19,413) in period 2 to 0.065% (28/43,405) in period 3 (P < .001). In cataract surgery, the overall rate of postoperative endophthalmitis was 0.125% (30/24,034). It decreased in each subsequent period, from 0.338% (9/2662) in period 1 to 0.224% (15/6696) in period 2 to 0.041% (6/14,676) in period 3 (P < .001). Coagulase-negative Staphylococcus was the most commonly isolated organism (47.4%). The rate of postoperative endophthalmitis decreased over a 20-year period at a single academic institution. Although multiple factors might have contributed to this decline, implementation of a preoperative prophylaxis protocol using copious povidone-iodine might have been the most important contributor. No author has a financial or proprietary interest in any material or method mentioned.

Anterior chamber bacterial contamination in cataract surgery.

BackgroundThe incidence of postoperative endophthalmitis has reduced during last several years to <0.01%; however, its associated complications continue to be devastating. Several sources of infection, including contamination by air, solutions, surgical instruments, intraocular lens, and wound leakage have been identified. The objective of this study was to evaluate the surgical technique, antibiotics, and asepsis that are used to reduce the risk of infection during cataract surgery.MethodsThis was a transversal prospective study, in which 64 cataract surgeries were evaluated from 32 patients, with 1 month recovery time; and cultures from preoperative and postoperative aspirates were analyzed. Two groups were established based on whether preoperative antibiotics were given or not. The analysis employed descriptive statistics.ResultsOf the 32 patients whose aspirates were obtained, three (9.37%) and 10 (31.25%) yielded positive cultures preoperative and postoperatively respectively. Staphylococcus species was the most common contaminating bacteria. The isolation of Staphylococcus species may indicate its potential as exogenous contaminant at time of wound closure. The cultures obtained from patients using preoperative antibiotics were positive for S. aureus in 10% (n = 2) of cases, and positive in 8.33% (n = 1) of cases not using antibiotics. The mean transoperative time with positive growth was 67 ± 17.8 minutes, and with negative growth was 76.3 ± 25.2 minutes. Two surgical techniques were evaluated: phacoemulsification and extracapsular extraction. The extracapsular technique showed a contamination rate of 33.33% (n = 8) compared to phacoemulsification with a rate of 25% (n = 2) (RR = 1.33).ConclusionsCommon contaminating microorganisms included the Staphylococcus species, which was isolated from the eyelids and ocular annexes at the time of wound closure. The isolation of microorganisms postoperatively could have been influenced by the surgical technique used, the surgical time, and the use of antibiotics.

A case-control study of post-operative endophthalmitis diagnosed at a Spanish hospital over a 13-year-period

A retrospective case-control study of patients who had undergone cataract extraction at a Spanish hospital over a 13-year period was conducted to identify the risk factors for developing post-operative endophthalmitis (POE). During the study period, the type of antibiotic prophylaxis was changed from subconjunctival gentamicin to the addition of both vancomycin and gentamicin to the irrigating solution. The overall incidence of POE was 0·19% (35 cases/18 287 operations). For the period prior to the change in antibiotic prophylaxis, the incidence rate of POE was 3·4 cases/1000 operations while in the latter period the incidence rate decreased to 0·34 cases/1000 operations. All patients who presented a virulent microorganism had a final visual acuity worse than 20/200. The only significant risk factor identified was the type of prophylaxis used (odds ratio 1·97, 95% confidence interval 0·94-4·14, P = 0·07). There were no significant differences between cases and controls although choice of surgeon approached significance.

The research advances of the perioperative pharmaceutical prophylaxis for postoperative endophthalmitis following cataract surgery

Postoperative endophthalmitis (PE) is the most dangerous complications of the cataract surgery. The incidence of PE is low, but the consequence is always devastating. The cataract surgeon paid much more attention on the prophylaxis of PE.Research results have been achieved in the different periods of perioperation.We reviewed the research literatures of infective routes, causative organisms, preoperative use of topical antibiotics and antiseptics, intraoperative and/or postoperative delivery of antibiotics.

Impact of Changes in Antibiotic Prophylaxis on Postoperative Endophthalmitis in a Spanish Hospital

Objective: This study aims to assess whether changes in antibiotic prophylaxis used in cataract surgery in the La Mancha Centro General Hospital, Spain, were associated with a reduced incidence of postoperative endophthalmitis (POE).Methods: The hospital employed two different antibiotic prophylaxis regimens during two clearly differentiated periods. In the first period (January 2000 to April 2003), subconjunctival injections of gentamicin were used while in the second (May 2003 to December 2008), vancomycin and gentamicin were added to the irrigating solution. During both periods, povidone iodine was used at the site of surgery and aminoglycoside eye drops were administered postoperatively. A Poisson regression model was used to evaluate the relationship between the incidence rate of endophthalmitis and variables such as time trends, seasonality, and change in antibiotic prophylaxis regimen.Results: During the period between 2000 and 2008, 26 cases of POE were detected after 14,285 operations for an incidence rate (IR) of 1.8 cases per 1000 procedures (95% confidence interval 1.2–2.7 cases out of 1000 procedures). In the period prior to the change in prophylaxis, 23 cases were detected (IR 4.5 cases/1000 procedures) while only three cases were observed in the period after the change (IR 0.3 cases/1000 procedures). A total of 84% of the microorganisms isolated were gram-positive, and all were sensitive to vancomycin.Conclusions: The change in antibiotic prophylaxis regimen for cataract surgery was associated with a relevant and significant decrease in the incidence of POE.

Clear corneal incision in cataract surgery

Since the introduction of sutureless clear corneal cataract incisions, the procedure has gained increasing popularity worldwide because it offers several advantages over the traditional sutured scleral tunnels and limbal incisions. Some of these benefits include lack of conjunctival trauma, less discomfort and bleeding, absence of suture-induced astigmatism, and faster visual rehabilitation. However, an increasing incidence of postoperative endophthalmitis after clear corneal cataract surgery has been reported. Different authors have shown a significant increase up to 15-fold in the incidence of endophthalmitis following clear corneal incision compared to scleral tunnels. The aim of this report is to review the advantages and disadvantages of clear corneal incisions in cataract surgery, emphasizing on wound construction recommendations based on published literature.

The incidence of postoperative endophthalmitis after cataract surgery in China: a multicenter investigation of 2006–2011

AimsTo estimate the cumulative incidence of postoperative endophthalmitis, identify risk factors and determine clinical outcomes in China.MethodsMedical records were reviewed for all patients with acute-onset endophthalmitis after cataract surgery from...

Minimally invasive vitreo retinal surgery: How small do we go?

The armamentarium of vitreo retinal surgeons has advanced tremendously with advances in physics and now the focus is on the maximum benefit that can be derived using micro incisions. The 23-G and 25-G systems have become fairly common and several studies have been done to determine the safety, advantages and disadvantages of small gauge sutureless surgery.[1] Though higher infusion and aspiration pressures are needed to remove the vitreous using small gauge probes, the corresponding damage on tissues is also substantially lower. My own experience with the small gauge vitrectomy system encouraged me to embrace this advancement in totality. My experience shows that the smaller gauge vitrectomy techniques shorten operating time and improve patient comfort. By minimizing surgically induced trauma, it decreases the post-operative inflammatory response and hastens recovery. Although higher pressures are needed for injection of silicon oil especially the heavy oil, the overall outcomes are much better. Various surgical procedures have been performed with microincision vitrectomy surgery (MIVS) but it is being advocated for macular holes and epiretinal membrane (ERM) surgery. Sandali et al. in their study[2] concluded that in ERM surgery 23-G and 25-G systems are as safe and effective as the 20-G system. They also noted that MIVS systems cause significant reduction in surgical time. Similar results have been reported by Haas et al.[3] I prefer a proportional mode vitrectomy for the separation of the membrane from the retina and it has given me excellent results. Concerns have been raised about the increased risk of endophthalmitis with 23-G and 25-G instrumentation. Oshima et al. in their study Multicenter survey with a systematic overview of acute-onset endophthalmitis after transconjunctival MIVS[4] found no significant difference in the incidence of post vitrectomy endophthalmitis between MIVS and 20-G vitrectomy similar results were observed by Bahrani et al.[5] Our experience is also similar as there have been no differences between the 20-G and MIVS in incidence of post-operative endophthalmitis. Nevertheless, the microsurgical task force came up with guidelines for minimizing endophthalmitis with vitrectomy surgery.[6] The advent of the 27-G instrument system, has given a totally new dimension to microsurgery.[7] For obvious reasons the fluid dynamics of the 27-G system are lower than 25-G MIVS. The pros and cons of the small gauge system will have to be weighed to decide how small we can go. The desired goal of surgery is to achieve optimal surgical results with minimal damage. Optimal utilization of the newer properties of machines in relation to the characteristics of the disease will have to be assessed to decide the risk benefit ratio of the MIVS system.[8] The risk of instrument bending, leading to lower stability and reduced cutting efficiency is a point for concern. This needs to be compared with improved wound healing and finer surgical results in select cases. I look at the future where further advances in technology will obviate the risks associated with the smaller gauge.

Infektionen nach Linsenchirurgie: Implikationen für die refraktive Chirurgie

Apart from the classical indication of removing an opaque lens that is compromising vision, extraction of the crystalline lens is gaining increasing importance as a refractive procedure. This literature review which considers the present guidelines of various ophthalmological societies and recently published studies is intended to give an estimate of the incidence of postoperative endophthalmitis and evidence-based recommendations for its prophylaxis, diagnosis, and therapy. The incidence of endophthalmitis after cataract extraction is reported to be 0.04% to 0.3% in most sizeable studies. Immediate sequential bilateral cataract surgery is internationally gaining popularity. It remains difficult to estimate whether or not the risk of endophthalmitis is affected with this approach. A toxic anterior segment syndrome (TASS) needs to be differentiated from postoperative endophthalmitis. TASS is an acute sterile inflammation after cataract surgery. Remnants of detergents and antiseptics on the surgical instruments are supposed to be main triggers. Additionally, the inappropriate preparation of solutions and antibiotics for intracameral use is considered to be a major cause. A case of TASS was also reported after implantation of an iris-fixated anterior chamber lens in a phakic eye. The cefuroxime solution that was prophylactically used in the ESCRS study and that is recommended for routine cataract surgery is not commercially available in Germany as a ready preparation for intraoperative application. Different measures are undertaken in different countries to prevent postoperative endophthalmitis, whose values are not exactly quantifiable. Antisepsis with povidone-iodine is still considered to be the component with the best evidence. For management of acute postoperative endophthalmitis, the systemic application of antibiotics is recommended in addition to their intravitreal injection. Few case reports have been published describing an infection after the implantation of refractive intraocular lenses (IOLs) in a phakic eye. However, we could not find meaningful information regarding the incidence of endophthalmitis after implantation of refractive IOLs. Based on the fact that these IOLs are not implanted into the capsular bag but in front of the crystalline lens or into the anterior chamber, and the presumably better anti-microbial immunity of this younger population compared to cataract patients, one may assume that the infection rate is lower than after cataract surgery. Nevertheless, a prospective register to document all endophthalmitis cases is desirable.

Intracameral antibiotics for the prevention of endophthalmitis in cataract surgery

Aim: To determine if there is enough evidence to support the use of intracameral antibiotics for the prevention of endophthalmitis post cataract surgery. Method: A systemic review of English language articles was conducted by performing a broad search using Medline/ProQuest, Science Direct, the Cochrane Library and Embase. The search was restricted to articles published between January 2005 and October 2010. The terms endophthalmitis and intracameral antibiotics were used to initiate the search but the term cataract was used for further exclusion. The population base incorporated adult patients undergoing cataract surgery. Limitations include one author as a reviewer of the titles resulting from the literature searches. A team review would give a more robust methodological quality. Results: Of the 493 results that were identified in the literature search 451 citations were excluded after screening titles and abstracts. Forty two publications were included for this review and were identified as being relevant after scrutiny. Publications showing retrospective data far exceeded the number of prospective case controlled studies negatively affecting the number of high quality articles reviewed. A randomized controlled study released by the European Society of Cataract and Refractive Surgeons (ESCRS) published results in 2006 showing a near _fivefold decrease in the rates of post-operative endophthalmitis with the use of intracameral cefuroxime. This study was discontinued due to ethical considerations. The study observed a clear benefit from the use of intracameral cefuroxime. Moxifloxacin has not been truly evaluated and has a potential for bacterial resistance. Topical antibiotics are unreliable relying on patient compliance and requiring frequent administration. From this review an effective solution for endophthalmitis prevention remains unclear. Conclusion: Intracameral cefuroxime administered at the time of surgery seems to work well for reducing the incidence of post-operative endophthalmitis as it is a broad spectrum and cost-effective antibiotic. The major barrier to its clinical use is the lack of a commercial preparation which increases the threat of dilution errors, which is known to be toxic to human endothelial cells.

Epidemiology of postoperative endophthalmitis in an Asian population: 11-year incidence and effect of intracameral antibiotic agents

To describe the incidence of postoperative endophthalmitis after cataract surgery in a multiethnic Asian population over an 11-year period, compare the endophthalmitis rates before and after the use of intracameral antibiotic agents, and identify potential risk factors for endophthalmitis. Department of Ophthalmology, Tan Tock Seng Hospital, Singapore. Cohort study. The incidence and risk factors for postoperative endophthalmitis in patients who had cataract surgery over 11 years were reviewed. Subconjunctival antibiotic agents only were administered over 7 years; in the subsequent 4 years, intracameral cefazolin (1.0 mg/0.1 mL) was used. The overall incidence of postoperative endophthalmitis in 50,177 was 0.042%. Over the 7 years without intracameral antibiotics, the endophthalmitis rate was 0.064% (19/29,539). With the use of intracameral cefazolin, the incidence decreased to 0.01% (2/20,638) (multivariate odds ratio [OR], 13.6; 95% confidence interval [CI], 3.15-58.58; P<.001). The independent risk factors for endophthalmitis were age (OR, 1.05; 95% CI, 1.01-1.09; P=.025) and male sex (0.06% versus 0.02%; OR, 2.96; 95% CI; 1.15-7.65; P=.025). There was a significant reduction in the rate of postoperative endophthalmitis in a multiethnic Asian population with the use of intracameral cefazolin. Men and older patients were at a higher risk for endophthalmitis. No author has a financial or proprietary interest in any material or method mentioned.

National disease registries for advancing health care

In Health Affairs on Dec 7, Stefan Larsson and colleagues report the results of a study of registries for diseases and procedures (cataract, heart disease, hip and joint replacement, cancer, and cystic fibrosis). They analysed 13 registries in Australia, Denmark, Sweden, the UK, and the USA. Sweden seems to have been quick to adopt disease registries and has almost 90 that are government supported. The national cataract registry has information on 95·6% of all cataract removals that were undertaken in Sweden since 1992 when the registry was established. Incidence of postoperative endophthalmitis, which is rare, fell from 0·11% in 1998 to 0·02% of all cataract surgery cases in 2009—the lowest reported national average—through the identification of associated risk factors. Sweden has also reduced the incidence of revision hip arthroplasty to 10% since the establishment of the registry in 1979 by identifying best clinical practice as well as implants that have the highest resistance to wear and tear. Swedish surgeons avoided about 7500 revisions and US$140 million in costs during 2000–09. If the USA could reduce its revision burden of hip arthroplasty to 10% by 2015, it would save $2 billion of a predicted total cost of $24 billion. Compared with Sweden, the USA seems to have been slow in establishing disease registries. Nevertheless, US evidence indicates the considerable benefits of registries. For example, the registry for cystic fibrosis is estimated to have averted roughly 5000 patient years of Pseudomonas infection and an associated cost of $230 million (about 2% of total costs for care of cystic fibrosis) from 2000 to 2009. Disease registries play an important part in improving health outcomes. They also reduce the costs of health care. Through the use of such registries, health-care providers can compare, identify, and adopt best practices for patients. The Swedish Government is committed to increasing its annual financial support for disease registries from $10 million to $45 million by 2013. Governments of more countries should follow Sweden's example.

Incidence of postoperative endophthalmitis after immediate sequential bilateral cataract surgery

To determine a best estimate of the incidence of endophthalmitis after immediately sequential bilateral cataract surgery (ISBCS) and assess the benefit of prophylactic intracameral antibiotics. Eye Foundation of Canada, Toronto, Ontario, Canada. Cohort study. A detailed literature search was performed to obtain recently reported frequencies of postoperative endophthalmitis with or without the use of prophylactic intracameral antibiotics. Members of the International Society of Bilateral Cataract Surgeons were surveyed. The data were collected to determine the results of unilateral and bilateral cataract surgeries performed by experienced bilateral cataract surgeons. The data were statistically analyzed. In recently published European prophylactic intracameral cephalosporin studies, the incidence of postoperative endophthalmitis after unilateral cataract surgery weight-averaged to 1 in 331 (0.3%) without prophylactic intracameral antibiotics and to 1 in 1977 (0.05%) with prophylactic intracameral antibiotics, whereas studies in the United States using only topical antibiotics reported infection rates as low as 0.028%. Four cases of bilateral simultaneous endophthalmitis after ISBCS have been reported in the past 60 years, all with breaches of aseptic protocol. No bilateral simultaneous endophthalmitis occurred in the 95 606 ISBCS cases collected. The overall rate of postoperative endophthalmitis after ISBCS was 1 in 5759. Infection rates were significantly reduced with intracameral antibiotics to 1 in 14 352 cases. The risk for postoperative endophthalmitis in ISBCS appears to be at least as low as and possibly lower than published rates for unilateral surgery, particularly when recommended precautions are taken. Intracameral antibiotics significantly reduced the risk for postoperative endophthalmitis.

Polyethylene Glycol Hydrogel Polymer Sealant for Vitrectomy Surgery

To test a novel hydrogel sealant to secure sutureless sclerotomies under variable intraocular pressure conditions. In cadaver eyes, 23- and 20-gauge (G) sclerotomies were constructed. Sixteen 23-G beveled sclerotomies were constructed in 4 eyes: 8 of the incisions were treated with hydrogel sealant, while 8 were left bare. All sclerotomies were monitored for leaks while the intraocular pressure was elevated. The pressure on incision leakage was recorded as the leak pressure (maximum tested = 140 mm Hg). Additionally, sixteen 20-G sclerotomies were constructed in 4 other eyes: 8 of the incisions were treated with hydrogel sealant, while 8 were sutured. These incisions were similarly pressure tested. Among the 23-G incisions, hydrogel sealant application to the incisions significantly increased the leak pressure relative to bare incisions: mean (SE), 131.8 (8.2) vs 39.5 (5.2) mm Hg, respectively (P < .001). Only 1 of the 8 sealant-treated 23-G incisions leaked below 140 mm Hg, compared with all of the 8 bare incisions. Among the 20-G incisions, there was no difference in leak pressure among sealant-treated and sutured incisions: mean (SE), 140.0 (0.0) vs 136.3 (3.8) mm Hg, respectively (P = .35). None of the 8 sealant-treated 20-G incisions leaked below 140 mm Hg, compared with 1 of the 8 sutured incisions. Hydrogel sealant significantly increased the leak pressure among 23-G incisions relative to 23-G bare incisions and was equivalent to suturing among 20-G incisions. Hydrogel sealants effectively close vitrectomy incisions and may decrease the incidence of postoperative endophthalmitis and hypotony.

Incidence of post-operative endophthalmitis following 23-gauge transconjunctival sutureless vitrectomy in the United Kingdom: a survey

Incidence of post-operative endophthalmitis following 23-gauge transconjunctival sutureless vitrectomy in the United Kingdom: a survey

Polyethylene Glycol Hydrogel Polymer Sealant for Closure of Sutureless Sclerotomies: A Histologic Study

To evaluate a polyethylene glycol-based hydrogel bandage for its ability to secure sutureless pars plana vitrectomy sclerotomies. Laboratory investigation. Twenty-gauge (20-G) and twenty-three gauge (23-G) sclerotomies were constructed in human cadaveric eyes. A total of 24 sclerotomies were constructed in 6 eyes. Four sclerotomies per eye were constructed. Two were straight 20-G incisions, of which 1 was sutured and 1 was covered with the bandage. The other 2 were 23-G beveled incisions, of which 1 was left bare and the other was closed with the hydrogel bandage. India ink was applied over the sclerotomy sites while the intraocular pressure (IOP) was varied. The presence of India ink particles along incisions was evaluated by histologic analysis. The hydrogel bandage prevented the entry of ink particles in all covered incisions after IOP modulation and incision manipulation. One 20-G sutured incision showed partial ink ingress. Four uncovered 23-G incisions showed the presence of ink within the inner aspect of the incisions (P = .0455 relative to 23-G sealed incisions). Twenty-two out of 24 incisions were evaluated, as 2 incisions could not be identified on histologic analysis. The use of a hydrogel bandage to close sutureless sclerotomies is a practical alternative to sutures. Closure of sutureless sclerotomies may reduce the entry of ocular surface fluid into these incisions as well as prevent leakage of intraocular fluid in the immediate postoperative period. Incision closure may reduce the incidence of postoperative endophthalmitis and hypotony in sutureless vitreous surgery.

Intracameral vancomycin following cataract surgery: An eleven-year study

To compare the incidences of endophthalmitis after cataract operations before and after introduction of intracameral vancomycin at the end of surgery. A retrospective analysis was performed of presumed infectious endophthalmitis after cataract surgery from January 1, 1998 to December 31, 2008. From January 2001, the practice of using intracameral vancomycin at the end of cataract surgery was introduced. The period before introduction of intracameral vancomycin is considered as period A and that after as period B. The incidences of presumed or culture-proven endophthalmitis during periods A and B were compared. A total of 16,606 cataract surgeries were performed during the study period. The incidence of endophthalmitis per 1000 cataract surgeries was 3.0 during period A and 0.08 during period B. This reduction was statistically significantly (Chi-squared test 36.6, P value < 0.0001). The relative risk of developing endophthalmitis without intracameral vancomycin prophylaxis was 38. The absolute risk reduction was 292 cases of endophthalmitis per 100,000 cataract surgeries. Intracameral vancomycin significantly reduced the incidence of postoperative endophthalmitis after cataract surgery. There is a universal need to adopt this mode of microbial prophylaxis to reduce the burden of endophthalmitis after cataract surgery.

A study on the incidence, microbiological analysis and investigations on the source of infection of postoperative infectious endophthalmitis in a tertiary care ophthalmic hospital: An 8-year study

Background:The objective of the study was the determination of the incidence of culture-proven postoperative endophthalmitis and probable sources of infection.Materials and Methods:It was a prospective study on the microbiology, incidence and probable sources of infection in patients with postoperative infectious endophthalmitis carried out in a tertiary care eye hospital. Consecutive patients diagnosed with postoperative infectious endophthalmitis during the years 2000-2007 were investigated for the causative infective agent and possible sources of infection. The surgical data and microbiological data including the investigations performed to trace the source were recorded in a specific formatted form and were gathered and compiled for analysis.Results:Data of analysis showed that 98 (0.042%) out of 2,31,259 patients who underwent intra-ocular surgery developed infectious endophthalmitis. Among these, 70 (0.053%) occurred after cataract, 10 (0.5%) after penetrating keratoplasty (PK) and 18 (0.018%) following other types of intra-ocular surgeries. The predominant infectious agents isolated were bacteria (89.7%), with equal proportions of Gram-positive and Gram-negative bacteria. Polymicrobial infection was noted in four and fungi in seven patients. Occurrence of postoperative endophthalmitis was sporadic and not related to any specific part of period in a year. Sources of infection were donor corneal rim in six post-PK patients and phaco probe in one who had postphacoemulsification endophthalmitisConclusions:Overall incidence of postoperative endophthalmitis over an 8-year period was quite low. The sources of infection could be established in six post-PK endophthalmitis patients and in a postcataract surgery.

Incidence of postoperative endophthalmitis in a high-volume cataract surgicentre in Canada

Objective: To determine the incidence of endophthalmitis at a high-volume, multisurgeon Canadian surgicentre and compare the endophthalmitis incidence, incision techniques, and prophylactic regimens with other published data in the worldwide literature. Design: Retrospective, consecutive case series. Participants: Patients (13931 eyes) who underwent cataract surgery at the Kensington Eye Institute, Toronto, Ont., from January 9, 2006, to January 6, 2008. Methods: Cases of endophthalmitis were identified from surgeon quality assurance reports. Prophylactic regimens, incision techniques, organisms cultured, and visual outcomes were reviewed in each case. All surgeons were surveyed regarding their incision techniques and prophylactic regimens. Results: Endophthalmitis developed in 6 eyes (incidence 0.043%). No causative organism predominated, and only 1 patient had severe vision loss to less than counting fingers. More cases of endophthalmitis (4 of 6) occurred in patients not receiving fourth-generation fluoroquinolones, despite ∼75% of surgeons using these drugs before and after surgery (odds ratio 6.3, relative risk 6.3). No intracameral antibiotics were used in any cases, and all incisions were clear corneal. Conclusions: Our incidence of postoperative endopthalmitis after cataract surgery was 0.043%. Slight evidence of reduced endophthalmitis with the use of fourth-generation fluoroquinolones was noted. Our endophthalmitis incidence compares favourably with other published rates in the medical literature, and this rate was achieved without intracameral antibiotic use in a centre that uses exclusively topical anesthesia and clear corneal incisions.

Incidence of post-cataract endophthalmitis at Aravind Eye Hospital: Outcomes of more than 42 000 consecutive cases using standardized sterilization and prophylaxis protocols

To report the incidence of postoperative endophthalmitis at a high-volume eye hospital in southern India using a modified cost-effective sterilization protocol. Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India. In this retrospective observational series at a single eye hospital, records of patients who had cataract surgery using a modified sterilization protocol from January 2007 through August 2008 and developed postoperative endophthalmitis within the first 3 postoperative months were drawn from a computerized database. The patient's socioeconomic status, the surgeon's experience, and the type of cataract procedure performed were analyzed as possible risk factors using the chi-square test/Fischer exact test. During the study period, 42426 cataract surgeries were performed. From these, 38 cases of presumed postoperative endophthalmitis were identified (incidence 0.09%). Thirty-five of the 38 cases were in the manual large- and small-incision extracapsular cataract extraction (ECCE) group, which had a statistically higher rate than the phacoemulsification group (P = .016). There was no statistical difference in the endophthalmitis rates between private patients and charity patients for either surgical method (manual ECCE or phacoemulsification). The modified sterilization and asepsis protocol adopted to facilitate high-volume cataract surgery in a clinical setting appeared to be safe and effective in preventing postsurgical endophthalmitis. Despite a 3:1 ratio of manual ECCE to phacoemulsification and the elimination of certain traditional sterilization practices, the rate of endophthalmitis in this generally underserved patient population with multiple risk factors for infection was comparable to that reported in other modern settings.