Original article
Acute-onset Endophthalmitis After Cataract Surgery (2000–2004): Incidence, Clinical Settings, and Visual Acuity Outcomes After Treatment

https://doi.org/10.1016/j.ajo.2005.01.025Get rights and content

Purpose

To report the incidence, clinical settings, and visual acuity outcomes of acute-onset endophthalmitis after cataract surgery.

Design

Retrospective, observational case series.

Methods

Annual cataract surgery statistics were determined by review of electronic surgical records. The clinical and microbiologic records were reviewed of all patients with clinically diagnosed endophthalmitis within 6 weeks after cataract surgery at a single university-affiliated hospital between January 2000 and November 2004. main outcome measures: Operative technique, intraoperative complications, and visual acuity.

Results

The incidence of acute-onset endophthalmitis after cataract surgery was 0.04% (7/15,920) for cataract surgeries of all methods, 0.05% (6/11,462) for cataract surgery by clear cornea phacoemulsification, and 0.02% (1/4,458) for cataract surgery by methods other than clear cornea phacoemulsification (P = .681, Fisher’s exact test). Six of seven (86%) cases occurred in the right eye, and all cases were performed by right-handed surgeons through temporal incisions. Five of seven (71%) patients had relative immune compromise. Four of seven (57%) patients had an intraoperative complication: vitreous loss in three patients and iris prolapse in one patient. Two patients had topical placement of lidocaine 2% gel before povidone-iodine preparation. The visual acuity at final follow up was 20/25 or better in four patients and count fingers or worse in three patients.

Conclusions

The incidence of acute-onset endophthalmitis after temporal clear cornea incision phacoemulsification is low (0.05%). Potential risk factors for endophthalmitis may include intraoperative complications, relative immune compromise, application of lidocaine 2% gel before povidone-iodine preparation, and inferior incision location.

Section snippets

Methods

The study protocol was approved by the Institutional Review Board of the University of Miami, School of Medicine. The study was a retrospective, observational case series. Annual cataract surgery statistics were determined by review of electronic surgical records. Surgeries were categorized as either clear cornea phacoemulsification or other methods of cataract surgery (phacoemulsification through scleral tunnel, extracapsular cataract extraction, or intracapsular cataract extraction). This

Results

The 5-year incidence rate of acute-onset endophthalmitis after cataract surgery was 0.04% (7/15,920) for cataract surgeries of all methods, 0.05% (6/11,462) for cataract surgery by a temporal clear cornea approach to phacoemulsification, and 0.02% (1/4,458) for cataract surgery through methods other than clear cornea phacoemulsification (P = .681, Fisher’s exact test). The incidence of endophthalmitis by year is displayed in Table 1.

The median age was 74 years (range: 50–83 years). Six of seven

Discussion

Controversy exists regarding the possible increased risk of postoperative endophthalmitis after cataract surgery through clear cornea incision. An experimental study of corneal wound dynamics in cadaver and rabbit corneas reported that even properly constructed corneal wounds may allow communication between the intraocular and extraocular environments.3 Some studies reported an increased risk of endophthalmitis in clear cornea cases,4, 5 whereas another reported no significant difference.6 The

John J. Miller, MD, is currently a vitreoretinal surgical fellow at the Bascom Palmer Eye Institute, where he also completed his residency. He obtained his graduate degree from the Medical College of Georgia. His primary research interests include ocular trauma and vitreoretinal infectious diseases.

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John J. Miller, MD, is currently a vitreoretinal surgical fellow at the Bascom Palmer Eye Institute, where he also completed his residency. He obtained his graduate degree from the Medical College of Georgia. His primary research interests include ocular trauma and vitreoretinal infectious diseases.

Supported in part by Research to Prevent Blindness, Inc., New York, New York.

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