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

Abstract Background To evaluate the characteristics, treatment patterns and outcomes of acute postoperative endophthalmitis. Methods Patients presenting with acute postoperative endophthalmitis between January 2017 to December 2019 were identified from hospital records in this multicentre retrospective cohort study. Clinical records were reviewed for visual acuity (VA) at various timepoints, cause of endophthalmitis, microbiological results, treatments and complications. Results Forty-six eyes of 46 patients were included. Intravitreal injections were the leading cause of acute postoperative endophthalmitis (n = 29; 63%), followed by cataract surgery (n = 8; 17%), vitreoretinal surgery (n = 7; 15%), and secondary intraocular lens insertion (n = 2, 4%). The absolute risk of endophthalmitis was 0.024% (1:4132) for intravitreal injections, 0.016% (1:6096) for cataract surgery, and 0.072% (1:1385) for vitreoretinal surgery. The majority of patients (n = 38; 83%) had better VA at 6 months compared to presentation, although fewer (n = 13; 28%) maintained similar or better VA compared to before the precipitating surgery. Twenty-four cases yielded positive culture results, of which staphylococcus epidermidis was the most commonly isolated organism. Microbiological yield was not associated with better final visual outcomes. Patients who underwent therapeutic vitrectomy (n = 15; 33%) had poorer VA at presentation, but subsequently achieved visual outcomes comparable to those who received medical treatment alone. There was no difference in time to presentation, visual outcome and retinal detachment rates among the different causative procedures. Conclusion Intravitreal injections were the most common cause of endophthalmitis in our region, primarily because of their higher frequency compared to other intraocular procedures. In this cohort, the primary procedure had no effect on presentation, management or visual outcomes.

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Faculty Opinions recommendation of Incidence of postoperative endophthalmitis after immediate sequential bilateral cataract surgery.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.714248001.789752901 ◽

2012 ◽

Author(s):

Kevin M Miller ◽

Alpa S Patel

Keyword(s):

Cataract Surgery ◽

Postoperative Endophthalmitis ◽

Bilateral Cataract

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Faculty Opinions recommendation of Is combined cataract surgery associated with acute postoperative endophthalmitis? A nationwide study from 2005 to 2014.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.733491079.793558724 ◽

2019 ◽

Author(s):

H Burkhard Dick ◽

Tim Schultz

Keyword(s):

Cataract Surgery ◽

Postoperative Endophthalmitis ◽

Nationwide Study

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Povidone-Iodine 3-Minute Exposure Time is Viable in Preparation for Cataract Surgery

European Journal of Ophthalmology ◽

10.5301/ejo.5000964 ◽

2017 ◽

Vol 27 (5) ◽

pp. 573-576 ◽

Cited By ~ 7

Author(s):

Chu L. Nguyen ◽

Lawrence J. Oh ◽

Eugene Wong ◽

Ian C. Francis

Keyword(s):

Clinical Practice ◽

Cataract Surgery ◽

Exposure Time ◽

Ocular Surface ◽

Povidone Iodine ◽

Bacterial Load ◽

Minute Exposure ◽

Visual Outcomes ◽

Preoperative Prophylaxis ◽

Operating Room Staff

Purpose Povidone-iodine (PI) is widely used to reduce the preoperative conjunctival bacterial load. This study aimed to evaluate the employment of PI 10% in an attempt to sterilize the ocular surface prior to cataract surgery, and to show that PI could be left in contact for 3 minutes. The viability of this exposure time in clinical practice, associated adverse events, and visual outcomes were documented. Methods In this prospective cohort study, phacoemulsification cataract surgery was performed in 604 patients by a single surgeon. Preoperative preparation was undertaken with PI 10%, applied to the cornea, conjunctival sac, eyelids, and periorbital skin with sterile cotton gauze. Povidone-iodine was then flushed onto the ocular surface. Operating room staff timed the precise duration of exposure. After the 3-minute preparation, the lids were thoroughly dried with fresh dry gauze. Results The median PI exposure time was 3.17 minutes, with an interquartile range of 0.25. All cases were followed up postoperatively at 1 day, 1 week, and 1 month. There were no complications attributable to PI. Visual outcomes were satisfactory. Conclusions Implementation of a preoperative prophylaxis protocol that used PI 10% with a 3-minute exposure time can be performed in clinical practice. The 3-minute exposure time had no adverse sequelae.

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