NOV 13, 2013
Cataract/Anterior Segment
This large, retrospective study of Chinese patients found an overall incidence of post-cataract surgery endophthalmitis of 0.03 percent.
To the authors’ knowledge, this is the first large-scale multicenter study of the incidence of endophthalmitis after cataract surgery in China. They reviewed the charts of all patients with acute-onset endophthalmitis after cataract surgery from January 2006 to December 2011 at eight tertiary care centers that account for more than 70 percent of the cataract surgeries in China.
After 201,757 cataract surgeries, there were 66 cases of presumed endophthalmitis, for a cumulative incidence of 0.033 percent. All eight eye centers achieved a low incidence of postoperative endophthalmitis, ranging from zero to 0.135 percent. Logistic regression analysis revealed that the risk of endophthalmitis increased with intraoperative communication with vitreous.
Visual outcome after endophthalmitis was generally poor. After a median follow-up of 153 days, only 44.6 percent of patients had a visual acuity of better than 20/70 and only 30.8 percent had better than 20/40. Baseline acuity of counting fingers or better was a strong predictor of good visual outcome.
Of 64 cases of presumed endophthalmitis tested, 25 (39.1 percent) were culture positive. Coagulase-negative Staphylococcus and Pseudomonas species were the most common organisms isolated, accounting for 72 percent of the culture-positive cases.
The authors note that two eye centers that used a combination of high-concentration vancomycin (1 mg/0.1 mL intracameral vancomycin injection or 100 mg/mL vancomycin in irrigating solution) and tobramycin as infection prophylaxis achieved a lower incidence of endophthalmitis than other centers (P < 0.001), and one of them had an incidence of zero.