Earlier endophthalmitis onset and worse presenting vision predict poor visual outcome

This retrospective case series analyzed all culture-positive endophthalmitis cases treated over a 10-year period at a large referral center that were diagnosed within six weeks of clear corneal cataract surgery. The 31 patients diagnosed during the first week after their surgery had a worse prognosis than the 42 diagnosed between eight and 42 days following their surgery, the study's authors found. Risk factors for poor visual acuity of 5/200 or worse at the final follow-up time included endophthalmitis diagnosis within one week of clear corneal cataract surgery, worse presenting vision, and a causative organism other than coagulase-negative species.

The authors compared the results of the current study to those reported in the Endophthalmitis Vitrectomy Study (EVS), which was published in the Archives of Ophthalmology in December 1995. Although outcomes were similar, cases of endophthalmitis following clear corneal cataract surgery in the current study appear to present later in the postoperative course than cases reported in the EVS study, which primarily included those with scleral incisions.

However, the question still arises regarding whether a properly constructed clear corneal incision presents a greater risk for endophthalmitis. Recent papers by authors, such as Howard Fine, MD, have demonstrated that when clear corneal incisions are properly executed, wound integrity is superb. This suggests that other factors, such as the performance of proper lid hygiene, prescription of preoperative antibiotics, use of Betadine immediately before surgery, and meticulous attention to isolating the lids and lashes from the surgical site, may play a greater role in the prevention of endophthalmitis.

Financial Disclosure
Dr. Hill is a consultant to Alcon, Carl Zeiss Meditec, and Santen. He also receives lecture fees from both Alcon and Carl Zeiss Meditec.