Postoperative Endophthalmitis Research Articles

Effects of Bacteriophage in Postoperative Endophthalmitis Caused by Staphylococcus aureus

Effects of Bacteriophage in Postoperative Endophthalmitis Caused by Staphylococcus aureus

Comparison of the aetiology, microbiological isolates and antibiotic susceptibilities of endophthalmitis between children and adults in southern China: a retrospective, cohort study

ObjectivesTo compare aetiology, microbiological isolates and antibiotic susceptibilities of endophthalmitis between children and adults.DesignRetrospective observational study.ParticipantsPatients admitted to Zhongshan Ophthalmic Center between January 2013 and December 2019 with clinically diagnosed...

Clinical Characteristics of K. pneumoniae Related Endogenous Endophthalmitis in China.

To investigate the clinical characteristics and systemic risk factors of K. pneumoniae related endogenous endophthalmitis (KPREE) in China and explore the possible pathophysiological mechanisms. This was a retrospective comparative study. All enrolled KPREE patients were followed up for at least 1 month to observe their clinical characteristics, unfavorable prognosis, and risk factors, and were compared with intraocular surgery-related postoperative endophthalmitis (ISRPE). Finally, a total of 15 eyes (3 both eyes) from 12 patients were enrolled in KPREE group, and 11 eyes (none both eyes) from 11 patients were enrolled in ISRPE group. Compared to the ISRPE group, the KPREE group had a higher percentage of fever (100% vs 9.09%, P = 0.000), liver abscess (91.67% vs 0%, P = 0.000), lung involvement (50.00% vs 0%, P = 0.024), and lower plasma albumin levels (24.1 [17.8, 31.7] vs 44.0 [37.7, 48.4], P = 0.001). Furthermore, Pearson's partial correlation analysis showed that fever (adjusted r = 0.592, adjusted P = 0.026) and plasma albumin (adjusted r = -0.658, adjusted P = 0.011) were independent factors associated with KPREE. In the KPREE group, ten eyes received 1-3 intravitreal antibiotic injections within one month. In the ten eyes that underwent injections, due to poor treatment reaction, four eyes experienced evisceration, and two eyes underwent vitrectomy with silicone oil tamponade at 1-month follow-up. And one eye developed sympathetic ophthalmia at 8-month visit. Patients with K. pneumoniae infection with hypoproteinemia or fever should be highly vigilant about the occurrence of KPREE, and more attention should be paid to the contralateral risk of KPREE or sympathetic ophthalmia.

Endophthalmitis Rates following Secondary Intraocular Lens Surgeries: An 11-year Medicare Fee-For-Service Analysis.

To assess postoperative endophthalmitis (POE) rates and risk factors after secondary intraocular lens (IOL) implantation for preoperative aphakia and IOL exchange combined with or without vitrectomy. Medicare fee for service (FFS) beneficiaries, United States. Retrospective study. Medicare FFS beneficiaries who underwent IOL exchange or secondary IOL implantation for preoperative aphakia between January 1, 2011 - November 19, 2022 were identified. POE rates were calculated overall and separately for each surgical category - secondary IOL for aphakia versus IOL exchange, with subsets for concurrent anterior or posterior vitrectomy. Multi-variate analysis of potential risk factors was implemented. 97,152 patients were included. The 42-day POE rates for secondary IOL implantation for aphakia and for IOL exchange were 0.35% and 0.28% overall, 0.31% and 0.30% when combined with posterior vitrectomy, and 0.84% and 0.42% with anterior vitrectomy. The risk of POE increased when secondary IOL surgery was combined with anterior vitrectomy compared to no vitrectomy (adjusted odds ratio [aOR] 1.849; p<0.001) and with higher Charlson comorbidity indexes compared to 0: 1-2 (aOR 1.495; p=0.01), 3-4 (aOR 1.591; p=0.01), 5-6 (aOR 1.617; p=0.046), ≥7 (aOR 3.290; p<0.001). Risk was decreased for IOL exchange compared to secondary IOL implantation for preoperative aphakia (aOR 0.783; p=0.04). The overall POE rate for all secondary IOL surgeries was 0.31% during the 11-year period. We hypothesize that absence of the posterior capsular barrier would explain the higher POE rates compared with cataract surgery, especially if a concurrent vitrectomy was performed with the secondary IOL procedure.

"Sterile hypopyon following pars plana vitrectomy and silicone oil injection".

To report five cases of post-operative sterile endophthalmitis in patients who underwent pars plana vitrectomy with silicone oil injection for retinal detachment. Review of the medical records of five patients who underwent pars plana vitrectomy with silicone oil injection at Southend University Hospital and the Royal Eye Infirmary, Derriford Hospital for rhegmatogenous or tractional retinal detachment. All five patients presented with signs of anterior chamber inflammation exhibiting flare, fibrin and hypopyon in the early or late post-operative period following vitrectomy with silicone oil injection. Treatment with topical antibiotics and steroids was commenced, with rapid resolution of the anterior chamber inflammatory reaction and no further intervention required. The use of silicone oil as a tamponade agent for retinal detachment can rarely induce sterile anterior chamber inflammation with signs resembling infectious endophthalmitis. Onset of symptoms, absence of pain and good response to topical steroids can help differentiate between the two entities.

Decade-long analysis of postoperative endophthalmitis in Sweden: Insights from insurance and national quality registers

PurposeTo analyse clinical characteristics and risk factors for post-operative endophthalmitis (POE) in a Swedish patient insurance database and compare prevalence of POE with two national quality registers. MethodsWe analysed 218 medical records of patients who claimed compensation for POE following ocular surgery from 2010 to 2020. The data were cross-referenced with national quality registers. ResultsIn total, 189 of 218 patients presented with severe ocular inflammation with no visibility into the posterior fundus and 160 of 218 had hypopyon. After treatment, the best corrected visual acuity improved from 2.4 to 1.8 LogMAR in mean (p < 0.01). Poorer visual outcome was associated with POE caused by Staphylococcus aureus, Enterococcus faecalis, and Streptococcus infections, as compared to coagulase-negative staphylococci (p < 0.01). Retinal detachment was linked to worse visual prognosis (p = 0.01). Eighteen patients required enucleation or evisceration, three of these had initially undergone vitrectomy, compared with 124 of 200 where the eyes were preserved. Peripheral vitrectomy showed better outcome compared to central vitrectomy (p = 0.02). Financial compensation was granted for 92 % of patients. However, a discrepancy was noted when comparing the number of patients with insurance claims to those reported by the national quality registers, indicating underreporting in both. ConclusionThis study highlights the impact of bacterial type on visual recovery in POE. Peripheral vitrectomy showed better outcomes than central vitrectomy. Most patients needing enucleation or evisceration were not treated with vitrectomy. Significant discrepancies were found between POE prevalence in quality registers and insurance reports, indicating the need for better reporting, though the exact magnitude of underreporting remains unclear.

Bacteriophage Therapy for Staphylococcus aureus Induced Postoperative Acute Endophthalmitis In Vivo

Background: Postoperative acute endophthalmitis is a rare but severe complication following cataract surgery, with bacterial pathogens such as Staphylococcus aureus being the leading cause. Despite declining incidence rates globally, visual outcomes remain poor in many cases. Recent studies have explored the potential of bacteriophage therapy to treat bacterial infections, particularly for antimicrobial-resistant strains. This study aimed to assess the therapeutic effectiveness of bacteriophage treatment in a rabbit model of S. aureus-induced acute postoperative endophthalmitis. Methods: The study employed a randomized, controlled, posttest-only design using New Zealand white rabbits. Following extracapsular lens extraction surgery, rabbits were injected with S. aureus intracamerally to induce endophthalmitis. The treatment group received additional bacteriophage therapy. Ocular inflammation was assessed by measuring two biomarkers, myeloperoxidase (MPO) and intercellular adhesion molecule-1 (ICAM-1), using enzyme-linked immunosorbent assay (ELISA) from vitreous fluid samples. Histopathological analysis of retinal and scleral structures was performed post-enucleation. Statistical analyses were conducted using independent t-tests. Results: The treatment group showed significantly lower ICAM-1 levels (p &lt; 0.001), indicating reduced leukocyte infiltration and inflammation compared to the control group. MPO levels were slightly elevated in the treatment group but were not statistically significant (p = 0.261). Histopathological examination revealed that retinal structures in the treatment group were preserved with reduced inflammatory cell infiltration, whereas the control group displayed extensive retinal damage, including neovascularization and retinal detachment. Conclusion: Bacteriophage therapy significantly reduced ocular inflammation and tissue damage in S. aureus-induced endophthalmitis, as evidenced by lower ICAM-1 levels and better-preserved retinal structures in the treatment group. These findings suggest that bacteriophage therapy may be an effective alternative to conventional treatments for postoperative acute endophthalmitis, particularly in cases involving antibiotic-resistant bacteria. Further studies are warranted to explore its broader clinical applicability.

Incidence of Acute Endophthalmitis after Secondary Intraocular Lens Implantation: A Nationwide Cohort Study

Plain Language SummaryIn this study, we analyzed the occurrence of acute endophthalmitis following secondary intraocular lens (IOL) implantation in South Korea. Using data from the National Health Insurance Service (NHIS)-National Health Information Database (NHID), we identified patients who underwent secondary IOL implantation or IOL exchange between 2002 and 2021 due to IOL dislocation or mechanical IOL complications. Postoperative endophthalmitis (POE) was defined as patients having received intravitreal antibiotic injection or vitrectomy for acute endophthalmitis diagnosed within 42 days after the claim for secondary IOL surgeries. Out of 39,364 patients who received secondary IOL implantation during the study period, acute POE was diagnosed in 62 patients, resulting in an overall incidence of 0.16%. The majority of POE cases were identified within the first-week post-surgery. In the univariate analysis, there was a higher incidence of endophthalmitis in patients with pre-existing glaucoma and those who underwent concurrent vitrectomy. Our findings suggest that the incidence of acute endophthalmitis following secondary IOL implantation in South Korea was similar to that of other nations. This study, based on retrospective claims data, represents the largest study of its kind in South Korean patients.

An unusual case of endophthalmitis

Postoperative endophthalmitis is an uncommon yet devastating complication after cataract surgery. We report a case of acute-onset postoperative endophthalmitis secondary to a rare causative pathogen Chryseobacterium. Elderly male patient with chronic kidney disease on hemodialysis with acute-onset postoperative endophthalmitis was managed with systemic and local higher antibiotics, leading to the resolution of the infection.

Electroretinographic Evaluations of Eyes With Endophthalmitis.

To determine the physiological status of the retina of eyes with endophthalmitis by examining the electroretinograms (ERGs) recorded with a portable recording system and to determine whether the pretreatment ERG findings were correlated with the best-corrected visual acuity (BCVA) after the treatment. We examined the medical records of 118 eyes of 108 patients who were diagnosed and treated for infectious endophthalmitis at Saitama Medical University Hospital, Japan, between January 2015 to November 2022. Of these, we studied the 25 eyes of 21 patients who had been evaluated by electroretinography. In bilateral cases, one eye was analyzed. The eyes were classified into those with postoperative endophthalmitis (group S, n = 12) and those with endogenous endophthalmitis (group E, n = 9). Photopic and flicker ERGs were recorded with the RETeval system. The pretreatment clinical factors studied were the ERG components that might be correlated with the post-treatment BCVA. Eyes in Group E with larger amplitude flicker ERGs (P = 0.0053, ρ = -0.8333) had better BCVA after treatment. In Group S, eyes with larger amplitude flicker ERGs (P = 0.0086, ρ = -0.7173), photopic a-waves (P = 0.0323, ρ = 0.6177), and photopic b-waves (P = 0.0055, ρ = -0.7443) had better BCVA after treatment. Simple and rapid ERG evaluations under light-adapted condition are helpful in evaluating the pretreatment retinal function and to determine the visual prognosis in eyes with endophthalmitis. Simple and non-time-consuming ERG evaluations are helpful in evaluating the retinal function in eyes with endophthalmitis and predicting the visual prognosis.

Endoftalmitis aguda tras facoemulsificación en un grupo oftalmológico privado

PurposeTo analyze the incidence, causes, risk factors and treatment of acute postoperative endophthalmitis (POE) after phacoemulsification in a private ophthalmological group. DesignUncontrolled retrospective observational study of all cases of POE over 22 years. Material and methods369,476 eyes were included after phacoemulsification in 41 surgical centers of the Clínica Baviera-AIER EYE Group from 2002 to 2023. POE cases were reviewed. ResultsThe general group was divided into two: group A (2002 to 2007), with vancomycin in the intracameral irrigation flow (27,705 eyes); Group B (2008 to 2023), with intracameral cefuroxime (341,771 eyes). 31 cases of POE were found (incidence, 0.0084%); 5 in group A (0.018%) and 26 in group B (0.0076%) (p=0.314), with a mean age of 67.3 years (14 men and 17 women). Cultures were positive in 14 cases in Groups A and B. Treatment was based on intravitreal antibiotics and vitrectomy. The mean time to symptom onset was 6.76 days and the mean time to resolution was 120.7 days. 12 eyes achieved corrected distance visual acuity ≥20/40. ConclusionsThe incidence of POEwas 0.0084% (0.0181% in group A and 0.0076% in group B). The probability of having POE in group A was 2.37 times greater than in group B (OR: 2.37; 95% CI: 0.71-6.2; p=0.079). The only significant risk factor for POE was posterior capsular rupture.

Incidence and outcomes of post-operative endophthalmitis following elective phacoemulsification cataract surgery, between 2015 and 2022.

Cataract surgery remains the commonest ophthalmic surgical procedure in the UK. Post-operative endophthalmitis (POE) is a sight-threatening complication. This study presents the incidence and outcomes of POE within Moorfields Eye Hospital NHS Foundation Trust (MEH) in London, UK. We conducted a retrospective, tertiary-centre study of the incidence and outcomes of POE following elective phacoemulsification cataract surgery between 2015 and 2022. We report a rate of 18 out of 154 826 (0.012%) cases of POE within seven weeks of cataract surgery. The age range was 43-87 years (mean age 67.1 years), and the male-to-female ratio was 1:1. Two cases were associated with intraoperative vitreous loss, one with anterior capsular tear extending to posterior capsular tear and the other with posterior capsular tear and dropped fragment. Two cases had a concomitant intravitreal injection, one of Triamcinolone Acetonide and the other of Dexamethasone implant (Ozurdex®), to manage chronic uveitic macular oedema. The majority of samples (89.9%) resulted in Gram-positive species. A final best corrected visual acuity (BCVA) of Snellen 6/36 or better was achieved in 12/18 (66.67%). The time from cataract surgery to suspicion of POE ranged from 3 to 44 days (mean 15.8 days). Eight cases (44.4%) required pars plana vitrectomy (PPV). We demonstrate an incidence of POE of 0.012% following phacoemulsification at MEH from January 2015 to December 2022. Such results are a testament to high-quality surgery, training supervision and post-operative care whilst adhering to local and international standards.

Endophthalmitis: a bibliometric study and visualization analysis from 1993 to 2023.

This study is designed to generalize and depict the research hotspots of endophthalmitis through bibliometric methods and software and analyze the evolutive tendency of the work on this severe disease over the past 30 years. This study employed a rigorous bibliometric approach. We identified all endophthalmitis-related literature by conducting a comprehensive search of the Science Citation Index Expanded database under the Web of Science Core Collection. The data was then analyzed and visualized using CiteSpace and VOSviewer, two widely recognized software tools in the field of bibliometrics. CiteSpace was used to analyze the country distributions, dual map overlay of journals, keyword bursts, and co-cited references. VOSviewer was employed to describe the authors and co-cited authors, the journals, the co-cited journals, and the keywords co-occurrence network. This robust methodology ensures the reliability and validity of the study's findings. A total of 2960 publications, including 2695 articles and 265 reviews, were included in this bibliometric study. There has been no shortage of endophthalmitis-related publications since 1993, with an apparent upward trend during recent years. Possible correlations with the COVID-19 pandemic are also analyzed. These studies were finished by 11,048 authors from 75 countries worldwide, with the United States in the lead. In the keyword co-occurrence network, except for the endophthalmitis term, cataract surgery becomes the keyword with the highest frequency. Different categories of endophthalmitis, including postoperative, post-injection, post-traumatic, and endogenous endophthalmitis, and antibacterial and anti-inflammatory therapies of infectious endophthalmitis, are discussed by categories. From the perspective of the timeline, postoperative and post-injection endophthalmitis were the dominant forms before and after the year 2000, respectively. Co-citation analyses reveal that the Endophthalmitis Vitrectomy Study (EVS) conducted in 1995 provides pivotal guidance for later research. Diverse pathogenic bacteria (e.g., Coagulase-negative Staphylococci, Propionibacterium acnes, Viridians Streptococci, and Bacillus cereus) or fungi (e.g., Candida, Aspergillus, and Fusarium) contribute to varying treatment principles and clinical prognosis, which should be taken seriously. In addition, intravitreal and intracameral antibiotics are the mainstay for treating and preventing infectious endophthalmitis, respectively. Our bibliometric analysis provides an overview of dynamic evolution and structural relationships in the research field of endophthalmitis. The displayed hotspots and developmental directions have reference values for future investigation.

Clinical characteristics and management outcome of acute infectious endophthalmitis.

This study aimed to investigate the demographics, clinical characteristics, and management outcomes of patients with acute infectious endophthalmitis (AIE). This retrospective chart review was conducted on all patients admitted with the clinical diagnosis of infectious endophthalmitis from 2017 to 2022. Demographic data, patients' clinical characteristics, the type of acute infectious endophthalmitis (post-operative, post-traumatic, bleb-associated, and endogenous endophthalmitis), the type of surgical procedure in the post-operative cases, the microbiologic analysis results of vitreous samples, therapeutic measures, and visual outcomes of patients were recorded. In this study, 182 participants, including 122 male (67%) and 60 (33%) female, were involved. The mean age of patients was 54.56 ± 21years, with a range of 1-88years old. The most prevalent type of AIE was post-operative (59.9%), followed by endogenous (19.2%), post-traumatic (17%), and bleb-associated (3.8%). The most common type of intraocular surgery in the post-operative subgroups of AIE patients was phacoemulsification (57.8%). The median (interquartile range) of the primary and final BCVA of patients was 1.5 (1.35, 1.85) and 0.65 (0.35, 1.35), respectively. Vitreous haziness grade (OR, 2.89; 95% CI, 1.11-5.74; p = 0.009) and the primary VA (OR, 60.34; 95% CI, 2.87-126.8; p = 0.008) revealed statistical significance for final vision loss. AIE is a devastating condition with poor visual outcomes, which presents with acute inflammatory signs and symptoms regardless of its type. However, prompt and appropriate treatment leads to visual recovery to a functional level in many patients.

Incidence of Postsurgical Intraocular Inflammation 6 Months After Implantation with a Multifocal Intraocular Lens.

This study assessed the incidence of postsurgical intraocular inflammation after cataract extraction by phacoemulsification and implantation with AcrySof IQ ReSTOR intraocular lenses (IOLs) produced using an updated manufacturing process. Incidence rates were compared with historical rates of postsurgical intraocular inflammation. This was a prospective, multicenter, post-approval study at 34 sites. Patients aged ≥22 years received a study lens in at least 1 eye. Postsurgical intraocular inflammation (aqueous cell grade ≥3+ within 14 days after surgery, aqueous cell ≥2+ at 14 to ≤60 days after surgery, or aqueous cell ≥1+ at >60 days) was assessed within a 180-day period after implantation. Rates of toxic anterior segment syndrome (TASS), acute postoperative endophthalmitis, chronic postoperative endophthalmitis, and uncategorized cases of postsurgical intraocular inflammation were assessed. Ocular adverse events (AEs) and ocular adverse device effects (ADEs) were evaluated. Historical rates of postsurgical intraocular inflammation were determined from the 2011-2013 Medicare Limited Data Set files (a 5% sample of the Medicare data set representative of patients aged ≥65 years). Final safety analysis set included 3357 eyes (1792 patients; mean age, 68.6 ± 7.9 years). Postsurgical intraocular inflammation (any type) rate was 5.1 per 1000 attempted IOL implants (95% CI, 2.95, 8.10). TASS, acute postoperative endophthalmitis, and uncategorized inflammation rates were 0.6 (95% CI, 0.07, 2.15), 0.3 (95% CI, 0.01, 1.66), and 4.2 (95% CI, 2.28, 6.99) per 1000 attempted IOL implants, respectively. There were no events of chronic postoperative endophthalmitis. Ocular AEs and ADEs were reported in 17% and 1.5% of eyes, respectively. Most common ADEs were halo (0.63%) and glare (0.51%). The historical postsurgical inflammation rate from 221,519 cataract procedures was 10.3/1000 cataract surgeries, and the endophthalmitis rate was 1.2/1000 surgeries. The updated IOL manufacturing process resulted in postoperative intraocular inflammation rates that were substantially lower than the historic rate.

PRIMARY VITREORETINAL LYMPHOMA MASQUERADING AS POSTOPERATIVE ENDOPHTHALMITIS IN A PREGNANT PATIENT WITH LONG-STANDING IDIOPATHIC PANUVEITIS.

To report primary vitreoretinal lymphoma after surgical 0.59 mg fluocinolone acetonide implant (FAi) exchange in a patient treated with adalimumab for idiopathic bilateral panuveitis. Retrospective case review. A 37-year-old woman with bilateral idiopathic panuveitis, who had favorable responses to previous FAi surgical implants, presented with right eye recurrent intraocular inflammation and cystoid macular edema that partially responded to systemic adalimumab. Her FAi was replaced, given her previous favorable response. She developed postoperative ocular inflammation transiently responsive to two serial vitreous taps and injections of intravitreal antimicrobials and then worsening inflammation and new layered flocculant material. Diagnostic vitrectomy showed a few atypical lymphocytes and cultures were negative. At postdiagnostic vitrectomy Month 1, flocculant material recurred. Aqueous cytology and flow cytometry revealed large CD45-positive B cells suspicious for lymphoma. Postoperatively, she revealed that she was pregnant. She was treated with eight monthly intravitreal methotrexate injections and postpartum consolidation radiotherapy. Subsequent repeat cytology, flow cytometry, and corneal pathologic examination revealed large B cells that were CD20 positive, and next-generation sequencing detected a dominant monoclonal B-cell population, diagnostic of PVRL. Nineteen months after FAi exchange, she developed an area of enhancement in the lateral aspect of the right frontal lobe on brain MRI, consistent with central nervous system involvement. The authors present a unique case of PVRL masquerading as postoperative endophthalmitis after FAi exchange in an eye with chronic panuveitis treated with adalimumab immunosuppressive therapy. The authors hypothesize that there may be a causal relationship between adalimumab and PVRL.

Phaeoacremonium parasiticum as a cause of postoperative cluster endophthalmitis

This case series highlights Phaeoacremonium parasiticum as the cause of postoperative cluster endophthalmitis. We present four cases of fulminant postoperative endophthalmitis following cataract surgery. The mean duration of onset of endophthalmitis-related ocular symptoms was 7.25 ± 0.5 days. Due to fulminant course of infection, the management involved multiple surgical interventions, with three patients requiring explantation of the intraocular lens.

Macular infarction in a case of acute postoperative endophthalmitis post intravitreal amphotericin B

To report a case of acute postoperative endophthalmitis that was complicated by macular infarction following intravitreal liposomal amphotericin B injection. A 76-year-old was diagnosed with acute endophthalmitis after uneventful phacoemulsification surgery and underwent pars plana vitrectomy with intravitreal antifungal (voriconazole). We switched to liposomal amphotericin B (5 µg/0.1 mL) from voriconazole in view of non-resolving exudates post vitrectomy. A few hours later, the patient complained of decreased vision, and fundus examination revealed an extensive area of macular infarction. The patient was continued on oral antifungal, and vitreal lavage with intravitreal dexamethasone was done. Optical coherence tomography angiography (OCT-A) at 6 months follow-up showed improved perfusion in the ischemic area, and the patient maintained a visual acuity of 20/80. Retinal toxicity can be a complication while treating post-vitrectomy patients with intravitreal amphotericin B. Early intervention may help in preserving vision by improving vascular perfusion at the macula.

Эффективность современных методов микробиологической диагностики инфекций в офтальмологии. Клинический пример

Purpose. To demonstrate the interaction of ophthalmic and microbiological services based on the use of technologies to minimize the time of microbiological diagnosis of ocular infection on a clinical example. Methods. A clinical example of an 82-year-old patient who underwent planned cataract phacoemulsification surgery with IOL implantation is presented. On the 3rd day after surgery, the patient was diagnosed with postoperative endophthalmitis. A rapid (48 h) microbiological diagnosis of the pathogen (E. faecalis), which made possible an early etiotropic adjustment of antibacterial treatment, provided maximum therapeutic effect, minimized the toxic side effects of pharmacotherapy and gave a good anatomical and functional result. Results The clinical case demonstrated organization of a precise interaction between ophthalmic service and the laboratory, which made it possible to identify the pathogen and determine the spectrum of its sensitivity to antibiotics during the first two days after diagnosis of postoperative endophthalmitis, prescribe etiotropic treatment with a good clinical and functional outcome. Key words: mass spectrometry; infection; microbiology; endophthalmitis.

Prophylactic Intracameral Antibiotics and Endophthalmitis After Cataract Surgery

Although the effectiveness of intracameral antibiotics to prevent postoperative endophthalmitis is described, selective use of antibiotics combined with 1% povidone iodine disinfection might be equally effective and could lead to cost reduction and avoidance of unnecessary use of antibiotics. To compare the incidence of postoperative endophthalmitis when 1% povidone iodine disinfection is applied in combination with selective intracameral antibiotics with the incidence after routine use of intracameral antibiotics in combination with 5% povidone iodine. This was a retrospective cohort study using incidence data from the ongoing endophthalmitis register of the Rotterdam Eye Hospital, a specialized hospital providing both secondary and tertiary ophthalmological care, when intracameral antibiotics were used only during cataract procedures with occurrence of a posterior capsular tear in comparison with results from cohorts described in the literature where routine antibiotics were used. All patients who had cataract (phacoemulsification) surgery at the Rotterdam Eye Hospital between 1993 and 2022 were included. No cataract surgical procedures combined with other intraocular procedures were included. Povidone iodine disinfection and intracameral antibiotics during cataract surgery either routinely or only in case of posterior capsular tears. Postoperative endophthalmitis incidence. Postoperative endophthalmitis incidence after 56 598 cataract (phacoemulsification) surgical procedures in the Rotterdam Eye Hospital between 2016 and 2022 was 0.000 (95% CI, 0.000-0.000). A PubMed literature search until September 2023 with respect to the incidence of postoperative endophthalmitis after routine antibiotic prophylaxis yielded 37 publications with an overall postoperative endophthalmitis incidence of 0.000 (95% CI, 0.000-0.000). No difference was observed between the postoperative endophthalmitis incidence during the last 7 years in the Rotterdam Eye Hospital and the overall postoperative endophthalmitis incidence after routine intracameral antibiotics prophylaxis as described in the literature. Disinfection with 1% povidone iodine in combination with selective antibiotic prophylaxis may be equally effective as routine antibiotic use and 5% povidone iodine.