Rate Of Postoperative Endophthalmitis Research Articles

United Kingdom survey of antibiotic prophylaxis practice after publication of the ESCRS Endophthalmitis Study

The European Society of Cataract & Refractive Surgeons Endophthalmitis Study published preliminary results in 2006 showing a near 5-fold decrease in the rates of postoperative endophthalmitis with the use of intracameral cefuroxime. The study findings have generated considerable controversy, and 1 year later its recommendations had been heeded by only 6% of American Society of Cataract and Refractive Surgery (ASCRS) members. This poll sought to gauge the uptake among surgeons in the United Kingdom and survey their response to its findings. Fifty-five percent of respondents were using intracameral cefuroxime; 48% had switched after publication of the ESCRS study. Of those remaining, 68% reported their main concern was the risk for dilution errors in the absence of a commercially preformulated preparation, with 67% stating they would switch if such a product became available. Sixty-eight percent considered the lack of a subconjunctival cefuroxime treatment arm within the study a major methodology flaw. Sixty-seven percent said they do not consider penicillin allergy a contraindication to intracameral cefuroxime use, with the remaining 33% opting for alternative antibiotic prophylaxis. The majority of United Kingdom and Ireland Society of Cataract and Refractive Surgeons members have switched to intracameral cefuroxime, despite the absence of previously preferred practice in the study design. The major barrier to its further use appears to be the lack of a commercially available preformulated preparation.

Profilaxis de la endoftalmitis postquirúrgica con cefuroxima intracamerular: experiencia de cinco años

To present the outcomes of prophylaxis of postoperative endophthalmitis following cataract surgery with intracameral Cefuroxime. A retrospective study was done on 4281 eyes that underwent cataract surgery from October 2003 to September 2008. All patients underwent phacoemulsification cataract surgery. All cases received an injection of 0.1 ml intracameral Cefuroxime (1 mg) at the end of surgery except those patients allergic to penicillin and cephalosporin until September 2007 and thereafter only those with demonstrated allergy to cefuroxime. The rate of postoperative endophthalmitis was 0.11% (5 cases). Four of them had a positive culture. We found no evidence of clinical ocular toxicity. Intracameral cefuroxime works very well for reducing the incidence of postoperative endophthalmitis. It appears safe to use and is easy to prepare.

The incidence of endophthalmitis following transconjunctival sutureless 25- vs 20-gauge vitrectomy

To determine the incidence of endophthalmitis following 25-gauge and standard 20-gauge vitrectomy. In this single-centre retrospective interventional case series, we evaluated the incidence of acute endophthalmitis occurring within the 14-day postoperative period in all patients who underwent pars plana vitrectomy between 1 November 2002 and 31 December 2006. A total of 3477 consecutive patients were identified. Of them, 3046 patients underwent 20-gauge vitrectomy and 431 underwent 25-gauge vitrectomy. The event rates of postoperative endophthalmitis were 0.03% (1 of 3046) after 20-gauge vitrectomy and 0.23% (1 of 431) after 25-gauge vitrectomy (P=0.23). In the endophthalmitis case that occurred after 25-gauge vitrectomy, a combined phacoemulsification cataract surgery was performed with the 25-gauge vitrectomy. Analyses of event rates of postoperative endophthalmitis after combining phacoemulsification cataract surgery and vitrectomy were 0% (0 of 170) for 20-gauge vitrectomy and 2.17% (1 of 46) for 25-gauge surgery vitrectomy (P=0.21). The incidence of postoperative endophthalmitis following 25-gauge vitrectomy and 20-gauge surgery is low. Although there is a trend suggesting an increased risk of endophthalmitis with the 25-gauge system, this difference was not statistically significant given the low number of measured outcomes.

Postoperative endophthalmitis: optimal management and the role and timing of vitrectomy surgery

To review the evolving role of pars plana vitrectomy, as well as other therapeutic modalities, in the treatment and prevention of postoperative endophthalmitis and its sequelae. Medline database searches and review of recent relevant literature on the prevention and treatment of postoperative endophthalmitis. Despite significant technologic advances in ophthalmic surgery and the ready availability of improved pharmacologic agents, the rates of postoperative endophthalmitis have dramatically increased over the last decade. New surgical procedures, interventions, and techniques have increased patient exposures to this serious surgical complication. Cause, presentation, and outcome vary significantly requiring a tailored approach to each case. Appropriate prophylaxis and good surgical technique remain the mainstays of prevention. Intravitreal antibiotics and pars plana vitrectomy remain the primary treatment options. Postoperative endophthalmitis is a complex and multifaceted entity with potentially grave visual consequences. It requires a multifaceted approach, including appropriate prevention and prophylaxis, rapid recognition, and aggressive management. Since publication of the Endophthalmitis Vitrectomy Study, improvements in pharmacologic agents and vitrectomy techniques have refocused debate on the role of early surgical intervention in this condition.

Prophylaxie des endophtalmies après chirurgie de cataracte

In this review, we report the most recent findings on antibiotic prophylaxis during cataract surgery. The ESCRS (European Society of Cataract and Refractive Surgeons) has published the results of a study using a cefuroxime injection in the anterior chamber at the end of cataract surgery. It was found that this antibiotic injection reduced the rate of postoperative endophthalmitis fivefold. Based on the analysis of the available literature, we summarize the relevant information consistent with evidence-based medicine. Finally, we provide additional practical tips on antibiotic prophylaxis such as asepsis and antisepsis to decrease postcataract endophthalmitis.

Patterns of perioperative prophylaxis for cataract surgery in Canada

Background: The objective of this study was to document prophylactic methods used for cataract surgery in Canada. Methods: The Web-based link to a password-protected, anonymous, online survey was e-mailed or mailed, between November 2004 and January 2005, to 800 ophthalmologists practicing in Canada. Results: Of the 239 respondents (30% response rate), 216 performed cataract surgery. Phacoemulsification was preferred by 99%. Topical antibiotics, of which moxifloxacin was the most common (32%), were used preoperatively by 78%. Intraoperatively, 98% used providone-iodine antisepsis of skin, 15% used intracameral antibiotics and 11% subconjunctival antibiotics. Postoperative topical antibiotics, of which moxifloxacin was the most common (30%), were used by 97%, and 1% routinely used postoperative systemic antibiotics. Prophylactic regimen was changed after vitreous loss by 39%, of whom 68% added systemic antibiotics. Reported mean rate of postoperative endophthalmitis occurring within the previous year was 0.088%. Community practicing ophthalmologists were more likely to use preoperative topical antibiotics ( p = 0.0016, χ 2). As case volume increased, surgeons were more likely to use intracameral antibiotics ( p = 0.0185, exact Mantel-Haenszel χ 2 test) and postoperative topical antibiotics ( p = 0.0044, exact Mantel-Haenszel χ 2 test), and less likely to use subconjunctival antibiotics ( p = 0.0011, exact Mantel-Haenszel χ 2). As time in practice decreased, surgeons were more likely to use postoperative topical antibiotics ( p = 0.0319, exact Mantel-Haenszel χ 2 test). Provincial region was associated with preoperative topical antibiotic use ( p = 0.0076, Fisher's exact test), intracameral antibiotic use ( p = 0.0314, Fisher's exact test), and subconjunctival antibiotic use ( p = 0.0373, Fisher's exact test). There was no association between reported rate of postoperative endophthalmitis and any form of perioperative antibiotic use. Interpretation: Prophylactic methods commonly used for cataract surgery in Canada include providone-iodine antisepsis and perioperative topical antibiotics. Intracameral and subconjunctival antibiotics are currently not common prophylactic methods. Systemic antibiotics are used prophylactically by a subset of ophthalmologists for cases complicated by vitreous loss.

Perspectives on antibiotics for postoperative endophthalmitis prophylaxis: Potential role of moxifloxacin

To aid the cataract surgeon's understanding of rational approaches to antimicrobial prophylaxis and place the European Society of Cataract & Refractive Surgeons (ESCRS) postoperative endophthalmitis study in perspective, a review was conducted of published and unpublished data on intracameral antibiotic use during cataract surgery and the antimicrobial efficacy, pharmacodynamics, ocular penetration, and safety of moxifloxacin. The ESCRS-sponsored study of postoperative endophthalmitis prophylaxis reported rates of presumed infectious postoperative endophthalmitis of 0.07% with intracameral cefuroxime treatment and 0.34% in control groups. Postoperative endophthalmitis after cefuroxime use was mostly due to cefuroxime-resistant gram-positive bacteria. Intracameral cefuroxime also requires extemporaneous compounding, has short-term stability, and carries a risk for hypersensitivity. Moxifloxacin, a fourth-generation fluoroquinolone, has potent and rapid bactericidal activity against the most common gram-positive postoperative endophthalmitis pathogens, has excellent ocular penetration after topical administration, and is available in a self-preserved ophthalmic formulation that has been shown safe and effective in preventing endophthalmitis when administered intracamerally in an animal model. Available data suggest that the optimum antibiotic regimen and route of delivery for cataract surgery antimicrobial prophylaxis require further study. Moxifloxacin offers many theoretical advantages that make it an attractive first-line choice for topical use and of interest for intracameral administration.

Endophthalmitis after Cataract Surgery: A Nationwide Prospective Study Evaluating Incidence in Relation to Incision Type and Location

To establish the nationwide rate of postoperative endophthalmitis (PE) after cataract extraction (CE) and to study the relationship between PE and type of incision and other possible risk factors.Prospective, multicenter, comparative, nonrandomized, observational study.All cataract surgeries in Sweden performed from January 2002 through December 2004 and all endophthalmitis cases in the same period that were reported to the Swedish National Cataract Register (NCR).Through a standard reporting form sent to the NCR, patient and operation technique data were recorded. In addition, PE cases with a traceable number to the main register were collected. Various parameters with a possible impact on endophthalmitis development were evaluated. Univariate analyses and logistic regression were statistical methods.The rate and etiology of PE; possible risk factors pertaining to patient history and operation technique, with a special emphasis on incision type and location; use of injector for the intraocular lens implantation; kind of prophylaxis; and presence of peroperative communication between the anterior chamber and vitreous.The overall rate of PE was 0.048% (109 cases in 225 471 CEs). Incidences of PE were 0.053% with clear corneal incisions and 0.036% with sclerocorneal incisions (P = 0.14, logistic regression analysis). The corresponding results were 0.040% for superior incisions and 0.055% for temporal incisions (P = 0.14). Communication between the anterior segment and vitreous was found to be a highly significant independent risk factor for PE (P<0.001), as were patient age > or = 85 years (P<0.001) and the nonuse of intracameral cefuroxime (P<0.001).The overall rate of PE after cataract surgery is low in Sweden, which may be a consequence of the widespread use of prophylactic intracameral cefuroxime. Only a trend for an increased risk of PE was detected for clear corneal and temporal wounds. The present data indicate that the use of clear corneal and/or temporal approaches will result in 1 additional PE case in approximately 5500 procedures on top of the PE rate after sclerocorneal or superior incisions, which was approximately 1 case in 2400 operations.

Endophthalmitis after Uncomplicated Cataract Surgery with the Use of Fourth-Generation Fluoroquinolones: A Retrospective Observational Case Series

To estimate the rate of acute postoperative endophthalmitis after uncomplicated cataract surgery in patients treated before and after surgery with 1 of 2 different fourth-generation fluoroquinolone ophthalmic drops for surgical prophylaxis. Retrospective, multicenter, observational case series. Included in this study were 20,013 patients from 9 cataract surgery centers in 7 states in the United States. Patients who had undergone uncomplicated phacoemulsification who received preoperative and postoperative topical fourth-generation fluoroquinolones for surgical prophylaxis between March 2003 and July 2005 were included in the study. The files of patients in whom acute endophthalmitis developed were reviewed and analyzed. Number and rate of endophthalmitis cases after uncomplicated cataract surgery. During the study period, the participating surgeons performed 20,013 uncomplicated surgeries. Of these, 16,209 patients (81%) received topical gatifloxacin and 3804 patients (19%) were treated with topical moxifloxacin as antiinfective prophylaxis. A total of 14 patients experienced endophthalmitis. The overall rate of endophthalmitis was 0.07%. There were 9 endophthalmitis patients in the gatifloxacin group and 5 endophthalmitis patients in the moxifloxacin group. The rate of endophthalmitis in the gatifloxacin group was 0.06% and the rate in the moxifloxacin group was 0.1%. The difference in the rate of endophthalmitis between the 2 groups was not statistically significant. In 10 of the patients, vitreous culture results were positive. Coagulase-negative staphylococci, followed by streptococci, species were the most commonly isolated organisms in the culture-positive patients. The overall rate of endophthalmitis after uncomplicated cataract surgery in patients treated with topical fourth-generation fluoroquinolones as antiinfective prophylaxis was 0.07%. This rate was within the range of previously reported rates of endophthalmitis in the literature. The difference in the observed rate of postoperative endophthalmitis in patients treated with moxifloxacin versus gatifloxacin was not statistically significant.

Prophylaxis against Infection in Cataract Surgery: A Survey of Routine Practice

To survey the routine practice of consultant ophthalmic surgeons in the United Kingdom in preventing postoperative endophthalmitis following cataract surgery. This is a cross-sectional questionnaire-based study. A questionnaire was sent to consultant ophthalmic surgeons in university teaching hospital ophthalmology departments in the United Kingdom. Questionnaires were sent to 391 consultant ophthalmic surgeons in 36 ophthalmology departments. The response rate was 55.0% (215 responses). Eleven (5.1%) did not perform cataract surgery routinely. Of the remaining 204 respondents, all performed phacoemulsification as routine. A total of 28 (13.7%) reported a 0% rate of postoperative infective endophthalmitis. Preoperative topical antibiotics were routinely prescribed by 12 respondents (5.9%). The most common immediately preoperative measure was the usage of povidone iodine (203 respondents, 99.5%). A total of 19 (9.3%) used an antibiotic infusion during surgery. Postoperative subconjunctival antibiotics were given by 138 (67.6%), most commonly cefuroxime. A total of 33 (16.2%) administered postoperative intracameral antibiotics. A total of 141 (69.1%) prescribed topical antibiotics after surgery, most commonly neomycin. None gave systemic antibiotics routinely pre-or postoperatively. The results show a wide variation of prophylactic measures used in the United Kingdom. The routine practices adopted reflect personal preferences, and were not necessarily evidence-based. Further prospective studies are required to provide evidence for the efficacy of these prophylaxis techniques.

Bacterial Endophthalmitis After Resident-Performed Cataract Surgery

To determine if there is an increased rate of postoperative bacterial endophthalmitis after resident-performed cataract extraction relative to the reported rates of experienced surgeons. Retrospective, observational case series. The operative reports of the resident-performed cataract surgeries at San Francisco General Hospital between 1983 and 2002 were reviewed. Cases of culture-positive bacterial endophthalmitis and vitreous loss were identified. Between 1983 and 2002, three cases (0.11%) of culture-positive bacterial endophthalmitis occurred after 2718 resident-performed cataract extractions. The overall vitreous loss rate was 6.7%. Two endophthalmitis cases were acute (Staphylococcus epidermidis, Streptococcus viridans), presenting within five days of surgeries complicated by vitreous loss, and one case was delayed-onset (Corynebacterium species) after Nd:YAG posterior capsulotomy after uncomplicated cataract extraction. Despite higher rates of vitreous loss, the rate of endophthalmitis following resident-performed cataract surgery remains comparable with the rates of more experienced surgeons.

Intracameral cefazolin as prophylaxis against endophthalmitis in cataract surgery

To evaluate the efficacy of prophylactic intracameral cefazolin in preventing endophthalmitis in cataract surgery. Service of Ophthalmology, St. Joan Hospital, Reus, Spain. In this noncontrolled retrospective observational study, all patients had uncombined cataract surgery from January 2001 to December 2004. All cases of postoperative endophthalmitis were related. The patients were classified into 2 groups. The first (n = 3650) had surgery between January 2001 and December 2002, and the second (n = 3618) had surgery between January 2003 and December 2004; the second group received a bolus of intracameral cefazolin instilled at the end of surgery. The rate of postoperative endophthalmitis was lower in the cases with intracameral injection at the end of surgery (0.055%) than in those without cefazolin injection (0.63%). No patients in the group with intracameral cefazoline developed corneal endothelium or retinal toxicity. Intracameral bolus injection of cefazolin (1 mg in 0.1 mL solution) in cataract surgery demonstrated prophylactic efficacy in diminishing the rate of postoperative endophthalmitis without toxic effects on the cornea or retina.

ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery

To report results in the European Society of Cataract & Refractive Surgeons (ESCRS) multicenter study of the prophylaxis of endophthalmitis after cataract surgery. Twenty-four ophthalmology units and eye clinics in Austria, Belgium, Germany, Italy, Poland, Portugal, Spain, Turkey, and the United Kingdom, with an administrative office in Ireland, coordinating center in England, and data management and statistical unit in Scotland. This partially masked randomized placebo-controlled multinational clinical study to evaluate prospectively the prophylactic effect of intracameral cefuroxime injection and/or perioperative levofloxacin eyedrops on the incidence of endophthalmitis after phacoemulsification cataract surgery began in September 2003 and was terminated early in January 2006. The study used random allocation of patients in a 2 x 2 factorial design. By the end of 2005, complete follow-up records had been received for 13 698 study patients. Such a clear beneficial effect from the use of intracameral cefuroxime had been observed that it was agreed it would be unethical to continue the study and to wait for the completion of all follow-up procedures before reporting this important result. If total reported cases of endophthalmitis are considered, the incidence rate observed in those treatment groups not receiving cefuroxime prophylaxis (23 cases in 6862 patients) was almost 5 times as high (odds ratio [OR], 4.59; 95% confidence interval [CI], 1.74-12.08; P = .002) as that in the groups receiving this treatment (5 cases in 6836 patients). If only cases proved to be due to infection are considered, the rate was more than 5 times as high (OR, 5.32; 95% CI, 1.55-18.26; P = .008) in the treatment groups not receiving cefuroxime. Although the use of perioperative levofloxacin eyedrops as prophylaxis was also associated with a reduction in the observed incidence rate of postoperative endophthalmitis, this effect was smaller and was not statistically significant, whether total reported cases or only cases proven to be due to infection are used in calculating the rates. As not all follow-up procedures are complete, it is possible that further cases of endophthalmitis may be reported; however, it is not expected that this will alter the main conclusion. Nevertheless, it is anticipated that successful completion of follow-up procedures in all patients will increase the total number in the study to approximately 16,000. Intracameral cefuroxime administered at the time of surgery significantly reduced the risk for developing endophthalmitis after cataract surgery.

Reduction of Endophthalmitis Rate after Cataract Surgery with Preoperative 5% Povidone-Iodine

Objective: Postoperative endophthalmitis reflects in part quality and safety aspects of cataract surgery. Preoperative 5% povidone-iodine was introduced as a quality improvement effort. This study evaluated the effect of this additional measure on the occurrence of endophthalmitis after cataract surgery. Method: Topical 5% povidone-iodine solution was applied onto the ocular surface just prior to transferring the patient into the operative theater for cataract surgery. Other prophylactic measures were allowed to continue as before. Patients developing postoperative intraocular inflammation and undergoing intravitreal antibiotic injection were included as occurrences of endophthalmitis. Alteration in endophthalmitis rate was analyzed using a ‘p control chart’ of a statistical process control method. The incidence in the povidone-iodine-receiving group was compared to those before implementation and concurrent nonreceiving groups. Result: The postoperative endophthalmitis rate showed a significant reduction after introduction of povidone-iodine. A year before, 9 of 3,052 eyes developed endophthalmitis (0.294%). After introduction, this occurred in 4 of 4,089 eyes receiving povidone-iodine (0.097%) and 1 of 502 nonreceiving eyes (0.199%) in the following 16 months. Despite the apparent lower rate, comparison between groups was not statistically significant. Moderate to severe but tolerable eye irritation after application was reported in 6.6%. No other adverse events were detected. Conclusion: Topical preoperative 5% povidone-iodine contributed an additional effect to the reduction of the postoperative endophthalmitis rate after cataract surgery. This measure was rather safe to apply as a prophylaxis against endophthalmitis in cataract surgery.

Post‐operative endophthalmitis and IOL material

Editor, We wish to thank Drs Kodjikian, Burillon and Freney for their valuable comments regarding intraocular lens (IOL) material and its relation to postoperative endophthalmitis (POE) described in the paper ‘Endophthalmitis following cataract surgery in Sweden. The 1998 National Prospective Survey’ (Montan et al. 2002a). One of the findings of this study was that acrylic lenses were significantly less associated with POE than polymethylmethacrylate (PMMA) and hydrogel lenses. In contrast to what the writers of the letter claim, we did not conclude that acrylic is a less permissive material for POE. On the contrary, the conclusion of our paper states that our data in this regard ‘should be interpreted with much caution’. The reason for this caution is obvious: detailed data regarding a number of parameters with possible relevance for POE were simply not available through the register form for the control group. Kodjikian et al. are thus perfectly right in their criticism regarding the lack of information on a number of factors that might alter the risk of postoperative infection, such as the exact design and property of the IOL (not only the optic material), the presence of any putative innate propensity for developing infection in the operated patient, and, factors we perceive as highly essential, the prophylaxis regime and perioperative complications. These shortcomings were also thoroughly addressed in the discussion section of the paper. We nevertheless think it is interesting to address the issue of IOLs in relation to POE in this crude form, as previous studies have identified increased associations between certain IOL materials and POE (Menikoff et al. 1991; Bainbridge et al. 1998; Montan et al. 1998). We have continued to publish data from the Swedish National Cataract Register (NCR) (Wejde et al. 2005). We believe that if there were important differences in the adhesiveness of bacteria to various lens materials, divergent patterns of POE frequencies would be found in a consistent manner. In such an event it would be feasible to perform a posthoc investigation in order to pinpoint the exact lens design and to screen for various risk factors in the disease group. We did not feel that such an assessment was warranted in the present paper because our forthcoming studies will be based on a far more extensive material. All the lens types cited in our first paper in Acta were in fact compared with one another and a consequent lowering of the p-value was performed, as is clearly stated in the methods section. The only statistically significant results found were between acrylic lenses and the two other materials mentioned above. Therefore, only the comparisons between acrylic lenses and these other types were presented, but the actual POE frequencies for all IOL types were reported in a table and could easily be calculated with a statistical program by anyone interested. Finally, Kodjikian et al. wish to have our comments on a previously reported finding that heparinized PMMA IOLs may protect against POE, which is at odds with the present results. This may be explained by the fact that the previous results were obtained in an era with a higher POE rate than is found presently in our country (0.25% versus the present incidence of 0.06–0.1%) (Montan et al. 2002b). In addition, the unfoldable heparinized PMMA IOL was not used as a back-up lens at the time, which seems to be the case presently, in that surgeons today use a rigid heparinized lens in the event of a capsular break, a perioperative complication which in itself may predispose to infection. The tendency to develop POE is certainly multifactorial and only large scale, prospective studies with meticulous protocols will be able to establish whether any IOL is more protective than others against POE. In the meantime, we believe that the ongoing POE registration through the NCR may provide some useful information in this respect.

Significant nonsurgical risk factors for endophthalmitis after cataract surgery: EPSWA fourth report.

Endophthalmitis remains a devastating complication of cataract surgery, despite improved methods of prophylaxis and surgical technique. The current study was conducted to identify sociodemographic, environmental, and clinical risk factors for the development of postoperative endophthalmitis, using population-based administrative data from Western Australia. The Western Australian Data Linkage System identified all patients who underwent cataract surgery, along with those in whom postoperative endophthalmitis subsequently developed, from 1980 to 2000 inclusive. Cases of endophthalmitis were cross-referenced with other sources and validated by medical record review. After selection and preliminary analysis of potential risk factors, multivariate logistic regression modeling was used to estimate odds ratios for the selected variables. Over the 21 years, 210 cases of endophthalmitis occurred after 117,083 cataract procedures, yielding a cumulative incidence rate of 1.79 per 1000 procedures. The incidence of endophthalmitis decreased for extracapsular extraction over the whole period, but not for phacoemulsification over the recent 12 years. There was no risk-adjusted difference in the incidence rate of endophthalmitis for the various cataract surgery procedure types. However, a significantly higher risk was found in patients aged over 80 years, in having surgery in private hospitals, and to a lesser degree in having same-day surgery and surgery in winter. Cataract surgery with lacrimal or eyelid procedures dramatically increased the risk of endophthalmitis. It may be possible to reduce the incidence rate of postoperative endophthalmitis by almost 80% with a systematic approach to the management of elderly patients, hospital stay, and clinical protocols.

Trends in cataract surgery and postoperative endophthalmitis in Western Australia (1980-1998): the Endophthalmitis Population Study of Western Australia.

Postoperative endophthalmitis results from an intraocular infection and usually occurs following cataract surgery. It has significant morbidity and causes severe visual impairment or blindness of the eye. The aim of this study was to assess the trends in the incidence rates of cataract surgery and postoperative endophthalmitis in Western Australia for the period 1980-1998. The Western Australian Record Linkage Project was used to link the morbidity records for all patients treated for cataract surgery in Western Australia in 1980-1998. Patient records were selected using the international classification for diagnosis and procedure codes pertaining to cataract surgery and postoperative endophthalmitis. All cases of postoperative endophthalmitis were validated by case-note review. The separate databases of the Royal Perth Hospital microbiology and anaesthetic departments as well as the vitreo-retinal surgeon logbooks were used to cross-validate the hospital morbidity database. Trends in the incidence rates of cataract surgery and postoperative endophthalmitis were assessed by Poisson regression. There were 94,653 cataract procedures performed for 63,007 patients in Western Australia during the 19-year period. The majority (88%) of cataract procedures performed were in patients aged 60 years or older. Postoperative endophthalmitis developed in 188 patients, with serious visual impairment occurring in 70.6% of patients for whom visual acuity data was available at presentation. The incidence rate of cataract surgery increased more than three-fold from 1981 (102 per 100,000 person years) to 1998 (345 per 100,000 person years), mainly due to the increase in extracapsular cataract extraction during the 1980s and phacoemulsification extraction from 1990 onwards. In contrast, the average annual incidence rate of postoperative endophthalmitis remained relatively unchanged at around 2 per 1000 cataract procedures over the same period. Cataract surgery is becoming more prevalent in the elderly as the life expectancy of the population increases. There has been a dramatic shift in surgical practice during the last 30 years with small-incision phacoemulsification being the predominant method of intervention used since 1990. Despite changes in surgical practice the incidence rate of postoperative endophthalmitis has remained the same.

Bacterial adhesion to rigid and foldable posterior chamber intraocular lenses: in vitro study

Purpose To determine the in vitro bacterial adherence to intraocular lenses (IOLs) routinely used at 1 center. Setting University Hospital of Vienna, Vienna, Austria. Methods Four types of rigid IOLs (hydrophobic poly[methyl methacrylate] [PMMA] and hydrophilic heparin-surface-modified PMMA) and 5 types of foldable intraocular lenses (hydrophobic silicone, hydrophobic acrylic, and hydrophilic acrylic) were used in the experiment. Under standardized conditions, the IOLs were contaminated with 2 strains of Staphylococcus epidermidis. A sonication method and impression method were used for quantification. The mean bacterial density per lens type (colony forming units/mm 2) was compared. Results With both germs and both quantification methods, more bacteria was found on hydrophobic lenses than on IOLs with hydrophilic surfaces ( P = .001). The Alcon AcrySof® and Askin UV80F® IOLs had the greatest and the Corneal Acrygel® and Bausch & Lomb Hydroview® IOLs the least affinity to these microorganisms. Conclusion The data suggest that hydrophilic IOLs can help reduce the rate of postoperative endophthalmitis as a result of their surface properties.

Acute-Onset Postoperative Endophthalmitis: Review of Incidence and Visual Outcomes (1995-2001)

To determine the incidence rate of acute-onset postoperative endophthalmitis and to assess visual acuity outcomes after treatment from the most recent 7 years (1995-2001) compared with the previous 11 years (1984-1994) among patients undergoing intraocular surgery at the same institution. The medical records were reviewed of all patients undergoing intraocular surgery at the Bascom Palmer Eye Institute between January 1, 1995 and December 31, 2001. The 7-year incidence rate of acute-onset postoperative endophthalmitis was 0.05% (17 of 35,916 intraocular surgeries). The number of patients with endophthalmitis (incidence) and their median final visual acuity for each surgical category are as follows: cataract extraction: 8/21,972 (0.04%) - 20/100; glaucoma surgery: 4/1,970 (0.2%) - 20/70; penetrating keratoplasty: 2/2,362 (0.08%) - light perception; pars plana vitrectomy: 2/7,429 (0.03%) - hand movements; secondary intraocular lens placement: 1/485 (0.2%) - 20/40. Of the 8 cases of endophthalmitis after cataract surgery, 6 cases occurred after phacoemulsification and 2 of these cases had a dear corneal sutureless incision. The most recent 7-year incidence rate of acute-onset postoperative endophthalmitis is significantly lower than that of the previous 11 years (0.05% versus 0.09%; = 0.031) at the same institution. Visual acuity outcomes after treatment were generally better in cataract surgery, glaucoma surgery, and secondary intraocular lens categories compared to pars plana vitrectomy and penetrating keratoplasty categories.

Endophthalmitis following cataract surgery in Sweden. The 1998 national prospective survey.

To investigate the morbidity of postoperative endophthalmitis (POE) following cataract surgery in Sweden in 1998. Clinically presumed cases of POE were reported in a prospective survey in which all Swedish ophthalmic surgical units except one had agreed to participate. Data on intraocular cultures and visual outcomes at 3 months after infection were supplied. Surgical cases that became infected were identified in the Swedish National Cataract Register, thereby enabling screening for various putative risk factors. The nationwide incidence of POE amounted to 58 cases out of 54 666 cataract operations, or 0.1% of surgical cases. The predominant aetiology was gram-positive bacteria, which comprised 57% of the material. Acrylic intraocular lenses were found to decrease the risk of POE significantly in comparison to hydrogel and polymethylmethacrylate lenses. The incidence of POE after cataract surgery in Sweden is similar to that currently reported elsewhere in the developed world. We hope that continued registration of cases of POE in Sweden will shed light on the possible influences of various prophylactic measures and different intraocular lens materials on the development of postoperative infection.