Rate Of Postoperative Endophthalmitis Research Articles

Endophthalmitis following cataract surgery and effect of different intracameral antibiotic regimes in Sweden 2011 - 2017. A national registry study.

To study the incidence, predictive factors, aetiology and visual consequences of postoperative endophthalmitis (PE) in relation to three intracameral antibiotic regimes. Swedish National Cataract Register (NCR) entries from 2011 through 2017. Observational retrospective study. PE incidence, influencing factors, bacteriology and visual outcome were analyzed with regard to the three major prophylactic IC protocols. The overall incidence of PE was 0.023% or 177 cases in 764 513 cataract procedures. Analyzed per intracameral regime, the rates of PE were 0.024% (126 cases in 514 916 surgeries) for cefuroxime, 0.020% (25 cases in 122 340 surgeries) for moxifloxacin and 0.017% (20 cases in 121 045 surgeries) for combined cefuroxime-ampicillin. Incidences were not statistically significantly different from one another. Gram-positive bacteria caused 89.0% of culture positive cases. Enterococci as pathogens were significantly more frequent with intracameral cefuroxime than with moxifloxacin, p = 0.006 or cefuroxime-ampicillin, p < 0.001, while streptococci other than enterococci were more common with moxifloxacin than with cefuroxime, p < 0.001. Bacterial susceptibility to the given antibiotics was demonstrated in 21.3% of PE cases treated with cefuroxime, which was statistically significantly lower than proportions found with cefuroxime-ampicillin, 60.0%, p = 0.015, or with moxifloxacin, 88.2%, p < 0.001. Visual outcome worse than 20/200 were similar in the groups ranging from 42.0% to 53.7%. No statistically significant differences in PE incidence or visual outcome results between treatment groups were demonstrated. However, differences in aetiology and bacterial sensitivity were found between the prophylactic intracameral treatments.

Bacterial and fungal flora of conjunctiva of patients presenting with cataract and their seasonal variation in Northern India

Objectives: The objective of this study was to study the microbial flora (bacterial and fungal) of the conjunctival sac of patients presenting with cataracts at a tertiary care hospital in North India. Materials and Methods: This observational cross-sectional study included 320 eyes from 238 patients presenting with cataracts. Three conjunctival swabs were collected from each eye and analyzed for the presence of aerobes, anaerobes, and fungal growth. Statistical Analysis: The data were analyzed using R statistical environment 4.0 software, along with the R Commander plugin “EZR.” Kruskal–Wallis rank sum test. In addition, the Fisher exact test was conducted, considering P &lt; 0.05 as statistically significant. Results: A total of 75.63% (242) of conjunctival sacs were culture-positive, with a predominance of bacterial growth. On the other hand, 24.37% (78) of conjunctival sacs were sterile. Common commensals isolated included Staphylococcus epidermidis (34.06%), Staphylococcus aureus (10.0%), Propionibacterium spp. (7.5%), and Corynebacterium spp. (5.31%). There were 23 (10%) Gram-negative cultures, whereas three fungi were isolated, all of which were Candida spp. The highest total growths were observed in age group 2 (51–65 years); however, no statistically significant correlation existed between age groups and growths. Season 1, characterized by temperatures between 10° and 15°, exhibited maximum growths. The most growths were coagulase-negative staphylococci (CONS). Conclusions: Our study of North Indian eyes revealed that 75.63% of healthy conjunctival sacs showed positive cultures, mainly CONS, with no seasonal trend. Given CONS’s prevalence in post-cataract endophthalmitis, routine pre-operative conjunctival swabs could guide prophylaxis and lower rates of post-operative endophthalmitis.

The impact of antibiotic prophylaxis with intracameral cefuroxime on postoperative infectious endophthalmitis rates in a high-volume cataract surgery center

Our purpose was to compare postoperative infectious endophthalmitis rates before and after the introduction of antibiotic prophylaxis via intracameral with cefuroxime (ATB-P IC) in a high-volume cataract surgery service. Retrospective cohort study considering patients who underwent cataract surgery at Ophthal Hospital Especializado, São Paulo, Brazil, from January/2011 to December/2019. Patients operated from 2013 to 2019 comprised the ATB-P IC group while those operated from 2011 to 2013 formed the control group without the ATB-P IC protocol. A total of 23,184 cataract surgeries were included, with 6,207 in the Control Group and 16,977 in the ATB-P Group. A significantly higher rate of endophthalmitis was observed in the control group (0.0967%) when compared to the ATB-P group (0.0177%) (p = 0.014). Surgeries performed with ATB-P showed 80% less chance of reported endophthalmitis (OR = 0.20; 95% CI 0.05–0.72; p = 0.014) than those without ATB-P. Of the six cases confirmed by culture in the control group, all tested positive for Pseudomonas aeroginosa and the only case confirmed by culture in the ATB-P group was positive for Staphylococcus epidermidis. Our findings strongly support the use of intracameral antibiotic prophylaxis with cefuroxime to reduce postoperative infectious endophthalmitis rates, and we recommend its incorporation into cataract surgery protocols.

Endophthalmitis rates and risk factors following intraocular surgeries in the medicare population from 2016 to 2019

AimsTo determine endophthalmitis rates and risk factors following intraocular surgeries in the Medicare population.MethodsRetrospective, cross-sectional study from 2016 to 2019 in Medicare fee-for-service and Medicare Advantage beneficiaries. 100% Medicare claims...

Incidence and Clinical Characteristics of Postoperative Endophthalmitis After Ab-Interno Canaloplasty.

Postoperative endophthalmitis (POE) is a rare but devastating complication of ophthalmic surgeries. Microinvasive glaucoma surgery (MIGS) procedures have become increasingly utilized for the surgical reduction of intraocular pressure (IOP). Ab-interno canaloplasty (ABiC) is a popular MIGS procedure, but POE rates and clinical effects following ABiC have not been studied. This study conducted a retrospective review of all consecutive cases of either standalone ABiC or combined ABiC with phacoemulsification performed at a tertiary care academic referral center from 2015 to 2021. Exclusion criteria included a history of incisional glaucoma surgery, retinal surgery, or additional concurrent microinvasive glaucoma surgery (MIGS) at the time of ABiC. The ratesof POE afterABiC were calculated with 95% confidence intervals (CI) based on the Clopper-Pearson exact method. Of 3256 cases of ABiC, one case (0.03%, 1/3256, 95% CI: 0.00-0.17%) of post-ABiC endophthalmitis was identified. The rate of POE in standalone ABiC was 0.00% (0/1332 cases, 95% CI: 0.00-0.28%), whereas the rate in combined ABiC with phacoemulsification was 0.05% (1/1924 cases, 95% CI: 0.00-0.29%). Additionally, the rate of POE following stand-alone cataract surgery, 0.10%, 11/11,470 cases, 95% CI: 0.05-0.17%), total cataract surgeries, 0.06% (17/28,013 cases, 95% CI: 0.04-0.10%), total MIGs, excluding ABiC, surgeries, 0.08%, (3/3845 cases, 95% CI: 0.02-0.23%) portray non-inferiority of ABiC in the risk of POE. The case of ABiC-POE presented four days after surgery and required a vitreous tap with intraocular injection of antibiotics and pars plana vitrectomy. No causative organism was identified. A final 1-year follow-up revealed a corrected distance visual acuity of 20/40 and stable glaucoma. The rate ofPOE after ABiC (1 per 3256 cases) is statistically non-inferior to the reported incidence of POE after otherMIGS and incisional glaucoma surgeries.

Changing operating room practices: the effect on postoperative endophthalmitis rates following cataract surgery

PurposeTo determine whether four new operating room (OR) protocols instituted because of COVID-19 reduced the cataract surgical postoperative endophthalmitis rate (POE).DesignRetrospective, sequential, clinical registry study.Methods85 552 sequential patients undergoing cataract...

Endophthalmitis Rates among Medicare Beneficiaries Undergoing Cataract Surgery between 2011 and 2019

To determine national incidence and risk factors associated with developing endophthalmitis after cataract surgery in the United States. Retrospective, cross-sectional analysis. Medicare beneficiaries aged ≥65 years undergoing cataract surgery between 2011 and2019. Medicare claims were used to identify all patients who underwent ≥1 cataract surgery between 2011 and 2019. Endophthalmitis cases within 90 days of the cataract surgery were identified using diagnostic codes. Patients with a history of endophthalmitis 12 months before their cataract surgery procedure were excluded. Annual and aggregate 9-year incidences were determined for all cataract surgeries and for stand-alone cataract procedures. A stepwise multivariable logistic regression model using generalized estimating equations was used to evaluate factors associated with occurrence of postoperative endophthalmitis. The 90-day postoperative endophthalmitis rate and patient risk factors associated with onset of endophthalmitis after cataract surgery. A total of 14 396 438 cataract surgeries were performed among Medicare beneficiaries between 2011 and 2019. The overall 90-day postoperative endophthalmitis rate was 1.36 per 1000 cataract surgeries for all cataract procedures and 1.30 per 1000 cataract surgeries for stand-alone cataract procedures. A decreasing trend was noted for postoperative endophthalmitis rates during the 9-year study period. On multivariable analysis, the risk of endophthalmitis after cataract surgery was increased for cases performed among those aged ≥75 years versus those aged <75 years (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.11-1.18), Blacks (OR, 1.13; 95% CI, 1.07-1.20), Native Americans (OR, 1.43; 95% CI, 1.19-1.73), and eyes with any history of invasive glaucoma surgery (OR, 1.40; 95% CI, 1.18-1.65). Cataract cases combined with retinal surgery (OR, 2.60; 95% CI, 2.15-3.16) and those performed when the Charlson Comorbidity Index (CCI) was greater than 0 also had an increased likelihood of developing endophthalmitis. The risk of endophthalmitis was lower for cases performed on women versus men (OR, 0.89; 95% CI, 0.86-0.92). The overall 90-day postoperative endophthalmitis rate after cataract surgery was 1.36 per 1000 cataract surgeries between 2011 and 2019. Patient age, gender, race, and CCI were associated with risk of endophthalmitis.

Subconjunctival antibiotics: an alternative to intracameral antibiotics for endophthalmitis prophylaxis in cataract surgery

Background: There has been an increase in the use of routine intracameral antibiotics for endophthalmitis prophylaxis in cataract surgery. However, this can be associated with serious adverse events. Previously, subconjunctival antibiotics were the preferred route but there is minimal literature directly comparing the two. Hence, the safest and most efficacious route of prophylactic antibiotic administration remains controversial. Purpose: To evaluate the efficacy and safety of subconjunctival with intracameral antibiotics for postoperative endophthalmitis (POE) prophylaxis in patients undergoing uncomplicated cataract surgery. Methods: A literature review was conducted in Cochrane and PubMed for studies that compared the efficacy of prophylactic subconjunctival and intracameral antibiotics for post-cataract endophthalmitis. Searches were not limited to English or study design. Results: Three observational studies showed that subconjunctival and intracameral antibiotics both reduced POE rates. Intracameral antibiotics demonstrated a high efficacy (OR = 0.25, 95% CI 0.13-0.46, p < 0.0001) but was also associated with increased potential complications. All studies were conducted in a sequential nature during which cataract surgery techniques and instrumentation have improved in recent years. Conclusion: In institutions with a high incidence of endophthalmitis, routine intracameral antibiotic use would be more appropriate. However, in facilities with lower rates of POE, the subconjunctival route of delivery can be an alternative due to its better safety profile.

Endophthalmitis Rate in Immediately Sequential versus Delayed Sequential Bilateral Cataract Surgery within the Intelligent Research in Sight (IRIS®) Registry Data

To compare the rate of postoperative endophthalmitis after immediately sequential bilateral cataract surgery (ISBCS) versus delayed sequential bilateral cataract surgery (DSBCS) using the American Academy of Ophthalmology Intelligent Research in Sight (IRIS®) Registry database. Retrospective cohort study. Patients in the IRIS Registry who underwent cataract surgery from 2013 through2018. Patients who underwent cataract surgery were divided into 2 groups: (1) ISBCS and (2) DSBCS (second-eye surgery ≥1 day after the first-eye surgery) or unilateral surgery. Postoperative endophthalmitis was defined as endophthalmitis occurring within 4 weeks of surgery by International Classification of Diseases (ICD) code and ICD code with additional clinical criteria. Rate of postoperative endophthalmitis. Of 5 573 639 IRIS Registry patients who underwent cataract extraction, 165 609 underwent ISBCS, and 5 408 030 underwent DSBCS or unilateral surgery (3 695 440 DSBCS, 1 712 590 unilateral surgery only). A total of 3102 participants (0.056%) met study criteria of postoperative endophthalmitis with supporting clinical findings. The rates of endophthalmitis in either surgery eye between the 2 surgery groups were similar (0.059% in the ISBCS group vs. 0.056% in the DSBCS or unilateral group; P= 0.53). Although the incidence of endophthalmitis was slightly higher in the ISBCS group compared with the DSBCS or unilateral group, the odds ratio did not reach statistical significance (1.08; 95% confidence interval, 0.87-1.31; P= 0.47) after adjusting for age, sex, race, insurance status, and comorbid eye disease. Seven cases of bilateral endophthalmitis with supporting clinical data in the DSBCS group and no cases in the ISBCS group were identified. Risk of postoperative endophthalmitis was not statistically significantly different between patients who underwent ISBCS and DSBCS or unilateral cataract surgery.

Postoperative endophthalmitis with and without intracameral moxifloxacin prophylaxis in a high volume surgery setting

ObjectiveThis study was conducted to understand the effects of intracameral moxifloxacin in decreasing the incidence of postoperative endophthalmitis after cataract surgery in an eye hospital with a high volume surgical...

Does cataract surgery in patients with concurrent lower lid malposition increase the risk of postoperative endophthalmitis?

ObjectiveTo evaluate the safety of performing cataract surgery prior to eyelid (entropion/ectropion) surgery in patients with concurrent cataract and lower eyelid malposition. DesignRetrospective case series. Participants and MethodsPatients with concurrent lower eyelid malposition and cataract undergoing cataract surgery before lower eyelid repair from 2013 to 2020 were identified from two ophthalmologists (M.L.W., G.R.). Both surgeries were performed by the same ophthalmologist, with eyelid repair completed at least 1 month following cataract extraction. Data analysis was performed with two-parameter estimations. The primary outcome was the postoperative endophthalmitis rate in this cohort. Results129 cases in 90 patients were found (86 involutional entropion and 43 involutional ectropion). No cases of endophthalmitis were encountered. Statistical analysis using the 95% Jeffreys interval for one-sample binomial proportion revealed an upper limit of 1.9%. The Agresti-Caffo interval of the proportional difference between the study procedure and historical incidence data of postoperative endophthalmitis following cataract surgery alone yielded an estimate of 0.8% with an upper confidence limit of 2.2%. ConclusionWe present preliminary evidence on the endophthalmitis risk in patients with concurrent lower eyelid malposition and cataract who undergo cataract surgery prior to eyelid repair. We propose that this strategy may be a viable option to expedite vision restoration and reduce the risk of recurrent lower eyelid malposition in select patients. More data are required to reach statistically significant noninferiority and show that a malpositioned lower eyelid is not a risk factor for postoperative endophthalmitis following cataract surgery.

Comparison of Visual and Anatomic Outcomes Following RRD Surgery Using 23-Gauge Versus 25-Gauge Vitrectomy: PRO Study Report No. 12.

Most surgeons now utilize small-gauge (23- or 25-gauge) pars plana vitrectomy (PPV) with or without scleral buckling for repair of rhegmatogenous retinal detachments (RRD), in addition to primary scleral buckle (SB), but comparative data between the two gauges are limited. This study is an analysis of primary RRD repairs comparing 23- versus 25-gauge vitrectomy for PPV or combination PPV/SB from January 1, 2015, through December 31, 2015, across multiple institutions. The primary outcome was single-surgery success and secondary outcomes included postoperative complications. There were 1,932 eyes that met inclusion criteria. There was no statistically significant difference in single-surgery success (82.9% vs. 83.8%; P = 0.6329). There were similar rates of postoperative hypotony, endophthalmitis, vitreous hemorrhage, and choroidal detachment. The findings were similar when analyzing only eyes that underwent primary PPV without SB. Both 23- and 25-gauge vitrectomy systems have similar anatomic and visual outcomes in the primary repair of RRD. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:70-76.].

Efficacy of intracameral antibiotics following manual small incision cataract surgery in reducing the rates of endophthalmitis: A meta-analysis.

Manual small incision cataract surgery (MSICS) is a widely used technique for cataract surgery in the developing world. Higher rates of postoperative endophthalmitis have been reported with this technique compared with phaco-emulsification. The purpose of this study was to evaluate the efficacy of prophylactic intracameral (IC) antibiotics in reducing the rates of postoperative endophthalmitis following MSICS. Systematic review and meta-analysis of patients undergoing MSICS. A literature search in PubMed and EMBASE databases was performed to identify studies published from October 1992 to April 2020 evaluating MSICS with a minimum of 500 eyes reported. Two authors independently assessed eligibility, extracted data and assessed the risk of bias. Heterogeneity was assessed using the I2 test. Twelve studies enrolling 1 494 307 eyes were included. IC antibiotics were used in 725 324 (48.5%) eyes. The risk ratio of developing endophthalmitis was 2.94 (95% CI, 1.07-8.12; P = .037) in eyes that did not receive IC antibiotics. Routine use of IC antibiotics may help to reduce the rates of endophthalmitis following MSICS and significantly improve the safety of this effective form of cataract surgery.

Distribution and risk factors of postoperative endophthalmitis in people with diabetes.

Purpose:To evaluate (i) the distribution of postoperative endophthalmitis (POE) in patients who underwent cataract surgery, (ii) risk factors in diabetic versus nondiabetic patients, and (iii) distribution of POE in those who had undergone rapid reduction of preoperative blood sugar levels versus those with normal blood sugar levels.Methods:Medical records were reviewed from January 1995 to July 2021. In total, 391 eyes of 391 patients who developed POE after cataract surgery were studied. Patients with POE were divided into Group A, patients with diabetes (n = 128), and Group B, patients without diabetes (n = 263), and the associations of various clinical factors in the two groups were studied. Patients with diabetes with raised random blood sugars (RBS) preoperatively were subjected to a rapid reduction of blood sugar (RBS <200 mg%) to be considered eligible for surgery. Microbiological profile of patients was examined.Results:The cumulative incidence of POE over 26 years was 0.09%. Those who underwent a rapid reduction in preoperative blood sugar levels had higher rates of POE (53.1%) compared with (46.9%) those with blood sugar levels under control (P = 0.486). Men with diabetes had 1.634 times higher odds of POE (P = 0.048), and those with diabetes and hypertension had 3.961 times greater odds of having POE (P < 0.001) when adjusted for age, alcohol, smoking, and socioeconomic strata and presence of posterior capsule rupture. Positive culture results were observed in 45/128 (35%) patients with diabetes and 71/263 (27%) patients without diabetes. Staphylococcus epidermidis was the most commonly identified organism and was detected in 10/45 (22%) in those with diabetes and 21/71 (29%) in those without diabetes of all the culture-positive cases.Conclusion:In patients with POE, the odds are greater for men with diabetes, those with a history of hypertension, as well as those who undergo a rapid reduction of preoperative blood sugar.

The Effectiveness of Intracameral Moxifloxacin Endophthalmitis Prophylaxis for Trabeculectomy

To analyze the effectiveness of intracameral moxifloxacin prophylaxis in reducing acute postoperative endophthalmitis after trabeculectomy and combined trabeculectomy plus cataract extraction. Retrospective clinical registry analysis. Patients undergoing either trabeculectomy or trabeculectomy plus cataract extraction at Aravind Eye Hospitals (AEH) between 2009 and 2018 (inclusive). Electronic health records data were analyzed before and after implementation of routine intracameral moxifloxacin, and acute postoperative endophthalmitis rates were compared. During 2015, routine intracameral moxifloxacin prophylaxis was added in a step-wise fashion throughout AEH. Date of implementation was used to create group 1 (without intracameral moxifloxacin prophylaxis) and group 2 (with intracameral moxifloxacin prophylaxis). The primary outcome was the difference in acute (≤6 weeks) postoperative endophthalmitis between groups 1 and 2. Review of culture results, visual acuity, and intraocular pressure also was performed for patients with endophthalmitis. Thirty-eight thousand nine hundred eyes (group 1) did not receive intracameral moxifloxacin, whereas 19 086 eyes (group 2) did. Although the rate of noninfectious postoperative complications was not significantly different (0.81% vs. 0.67%; P= 0.07), a significantly lower rate of acute postoperative endophthalmitis was found in group 2 versus group 1 (0.03% vs. 0.08%; P= 0.03). Patients receiving intracameral moxifloxacin showed approximately 2.5-times lower odds of infection (odds ratio, 0.39 for group 2 vs. group 1; 95% confidence interval, 0.16-0.95) and almost 4-times lower odds after adjustment for covariates (odds ratio, 0.26 for group 2 vs. group 1; 95% confidence interval, 0.09-0.74). The rate of early postoperative infection after intracameral moxifloxacin introduction was lower for patients undergoing both trabeculectomy alone (0.09%-0.03%; P= 0.27) and combined trabeculectomy plus cataract extraction (0.08%-0.03%; P= 0.06). Although most cultures yielded no growth, no Staphylococcus or gram-negative growth was found for patients in group 2, who received intracameral moxifloxacin. Intracameral moxifloxacin prophylaxis was associated with a nearly 4-fold lower rate of early postoperative endophthalmitis in patients undergoing trabeculectomy or combined trabeculectomy plus cataract extraction.

Efficacy and Side Effects of Intracameral Moxifloxacin as Prophylaxis after Cataract Surgery

Purpose: To determine the efficacy of intracameral moxifloxacin at the end of cataract surgery.&#x0D; Methods: Retrospective record based study. Study was based on a consecutive case series of patients who had cataract surgery during 2009 through 2019 in the Department of Ophthalmology at Maharishi Vashishth State Medical College, Basti (India). Intracameral preservative free moxifloxacin injection was given at the conclusion of surgery to most patients. Standardized operating room and sterilization protocols were used. All The medical records were reviewed for the 8 weeks after surgery. Post-operative endophthalmitis rate was computed using the number of cases of postoperative endophthalmitis as the numerator and the number of cataract surgeries as the denominator.&#x0D; Results: Of the 10,108 surgeries performed during study period, 2012 (19.9%) involved intracameral moxifloxacin injection. No adverse drug reactions were reported from administration of intracameral antibiotics during the study period. The post-operative endophthalmitis rate in patient who had not received intracameral antibiotic injection was 0.06%. There was no endophthalmitis case reported in patients who had received intracameral moxifloxacin injection as prophylaxis.&#x0D; Conclusion: The results of this study support the use if intracameral moxifloxacin as a routine prophylaxis for endophthalmitis after cataract surgery. Especially in rural setting as the patients postoperative instruction compliance is poor and many patients are lost to follow-ups sue to different reasons.

Qualitätsmanagement an der Klinik für Augenheilkunde des Universitätsklinikums Freiburg: Was nutzt das Erheben von Qualitätsparametern?

All hospitals in Germany have a legal obligation to carry out internal quality management (QM). This means enormous costs as well as a burden for the employees through QM-specific tasks. The benefits can be advertising through certification, higher quality and safety for the treated patients and thus greater patient and employee satisfaction. The aim of this work is to compare effort and benefit of a QM system in ophthalmology. The surgical quality parameters already published in the annual reports, the available data of the QM handbook via the digital QM portal and patient feedbacks from 2004 to 2018/2019 were evaluated. In 2004, a quality management system was established for the first time in the Eye Centre at the Freiburg University Hospital. From 2005 to 2017, the entire hospital was KTQ-certified. In order to analyse the quality of surgery and patient safety, different surgical quality parameters were collected over the years with a constantly increasing number of operations. The majority of the quality parameters have remained stable or even decreased over the years. A peak in the postoperative endophthalmitis rate of 0.14% in 2015 and the decreasing percentage of cataract operations under topical anaesthesia in recent years were striking. The QM handbook was slimmed down. The analysis of clicks shows that the documents are increasingly used by the employees. The statistics of patient feedbacks show that this is a tool that is used quite frequently by patients to provide feedback on their stay and that the feedback is often positive. To operate quality management over many years, i.e. in our case to collect data of surgical quality parameters, to maintain the QM manual and to process patient feedbacks, means considerable effort. However, only the analysis of these parameters provides an insight into the current state of our clinic, from which conclusions can be drawn as to where processes or treatments can be optimised, which in turn can increase employee and patient satisfaction. Overall, transparency is increased and creates confidence for future treatments at the Eye Centre at the Freiburg University Hospital.

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.

Prophylactic intracameral cefazolin and postoperative topical moxifloxacin after cataract surgery: endophthalmitis risk reduction and safety results in a 16-year study.

This large retrospective observational study describes the evolution of the rates of postoperative endophthalmitis in cataract surgery in a 16-year period, and compares them before and after two different changes in the prophylaxis protocol of a general hospital in Barcelona, Spain. This study included all the phacoemulsification procedures performed from January 2002 to December 2017. In January 2004, intracameral cefazolin at the end of the surgery was added to the prophylaxis protocol of cataract surgery. In January 2011, topical postoperative ofloxacin was replaced by topical moxifloxacin. Cumulative incidences of postoperative endophthalmitis before and after the addition of intracameral cefazolin and the change of ofloxacin by moxifloxacin as postoperative topical treatment were compared. The study included 55,984 surgeries. In the period after the introduction of intracameral cefazolin (2004-2010), the cumulative incidence of endophthalmitis was 0.047% (95% CI 0.019-0.099%), significantly lower than in the previous period. From January 2011 to December 2017, after the postoperative change of topical ofloxacin by moxifloxacin, the cumulative incidence dropped to 0.0037% (95% CI 0.000468-0.01862%), with a relative risk reduction between both periods of 91.3%. An intracameral bolus of cefazolin was a very effective prophylaxis of endophthalmitis in cataract surgery. The continuous surveillance and prophylaxis protocol revision over time further reduced the incidence of this complication to extremely low levels.

Endophthalmitis reduction with intracameral moxifloxacin in eyes with and without surgical complications: Results from 2 million consecutive cataract surgeries

To analyze the posterior capsule rupture (PCR) rates among staff and trainee cataract surgeons, and the postoperative endophthalmitis (POE) rates in uncomplicated and complicated eyes both with and without intracameral moxifloxacin prophylaxis (ICMP). Ten regional Aravind Eye Hospitals in India. Retrospective multicenter clinical registry within a single hospital network. POE rates with and without ICMP were statistically compared for all eyes and separately for trainees versus staff, for phacoemulsification versus manual small-incision cataract surgery (M-SICS), and for a subgroup of eyes complicated by PCR or requiring secondary surgery. All cataract surgeries (2 062 643) performed during the 8-year period from 2011 to 2018 at the 10 regional Aravind Eye hospitals were included in the analysis. With ICMP, the overall POE rate declined from 692 (0.07%) of 993 009 eyes to 185 (0.02%) of 1 069 634 eyes (P<.001). This was independently significant for phacoemulsification and for M-SICS (P<.001). The overall PCR rate was 28 352 (1.37%) of 2 062 643 eyes, and it was statistically higher for trainees irrespective of surgical method (P<.001). Both staff and trainee surgeons had higher PCR rates with phacoemulsification than with M-SICS (P<.001). Absent ICMP, PCR increased the overall POE rate by more than 7-fold to 63 (0.43%) of 14 505 eyes. ICMP reduced the POE rate after PCR to 25 (0.18%) of 13 847 eyes (P=.002). This ICMP benefit was separately significant for both M-SICS (0.54% vs 0.26%, P=.01) and phacoemulsification (0.29% vs 0.06%, P=.005). The POE rate was especially high after secondary IOL implantation (0.90% without ICMP vs 0.34% with ICMP; P=.10). ICMP reduced the POE rate overall, with phacoemulsification, with M-SICS, and in eyes with PCR.