Contaminated irrigation solution common cause of postop endophthalmitis outbreaks

This retrospective review found that endophthalmitis outbreaks following cataract surgery often involve gram-negative organisms, can be associated with poor visual outcomes, and are most commonly caused by contaminated irrigation solution.

The authors performed a systematic review of 27 reports of endophthalmitis outbreaks following cataract surgery between 1985 and 2011.

The two most common causes associated with the outbreaks were contaminated solution (37 percent) and contaminated phacoemulsification machines (22.2 percent). Other possible sources of contamination included ventilation systems (11.1 percent) and defective sterilization (11.1 percent).

Bacteria occurred in 85.2 percent of cases and fungus in 14.8 percent. Causative organisms were gram-negative bacteria in 65.2 percent, gram-positive bacteria in 21.7 percent, and both gram-positive and gram-negative bacteria in 13.1 percent. Pseudomonas aeruginosa was causative in 51.8 percent of gram-negative bacteria cases.  

A visual acuity outcome of 20/400 or better was achieved in 55.5 percent of cases. However, the authors note that one of the outbreaks caused by Fusarium was associated with contamination during reconstitution of cefuroxime used for intracameral endophthalmitis prophylaxis at the end of cataract surgery. Eight patients were infected with Fusarium, and only three attained a final visual acuity of 20/400 or better.

They conclude that although outbreaks of acute-onset postoperative endophthalmitis following cataract surgery are rare, it is important to learn from such outbreaks by instituting ongoing surveillance and infection control measures.