Acute Infectious Endophthalmitis After Cataract Surgery: Epidemiological Characteristics, Risk Factors and Incidence Trends, 2008–2019

Abstract

Objective Intended to investigate the epidemiological characteristics, risk factors and incidence trend of endophthalmitis after cataract surgery in recent 12 years. Methods A retrospective study was conducted on the patients who underwent cataract surgery in Qingdao Eye Hospital from January 1, 2008, to December 31, 2019, including age, sex, history of diabetes, intraoperative operation and complications. In addition, the related risk factors and incidence trend of acute infective endophthalmitis were analyzed. The incidence of endophthalmitis and its related factors were analyzed by univariate and multivariate logistic regression analysis. Results A total of 55,612 cases of cataract surgery were performed in our hospital in 12 years, and 42 cases of acute infective endophthalmitis occurred (the incidence rate was 0.076%). The average occurrence time was 10.57 days ± 11.17, with eye pain as the main complaint and anterior chamber fibrin exudation as the main clinical manifestation. In addition, there were eight cases of anterior chamber hypopyon and 18 cases of vitreous reaction, the results of anterior aqueous humor or vitreous fluid culture in 10 patients were positive. Univariate analysis showed that intraoperative rupture of posterior capsule, non-use of antibiotics and non-use of behind-the-lens washout were the risk factors of infectious endophthalmitis after cataract surgery (P=0.032, P=0.000, P=0.000). Besides, multivariate logistic regression analysis showed that intraoperative rupture of posterior capsule was the main risk factor. Conclusion The occurrence of endophthalmitis after cataract surgery is mainly related to intraoperative rupture of posterior capsule, absence of antibiotics and behind-the-lens washout. In addition, the incidence of endophthalmitis after cataract surgery decreased during the past 12 years.

Characterizing the microbiota of instrumentation in ophthalmology clinics during and beyond the COVID-19 pandemic

“…While S. epidermidis was seen among the commensal bacteria in study team member samples, it was also the most frequently grown bacterium among all samples. This bacterium is one of the most common causes of post-intraocular surgical infection [ 12 ]. In addition to S. epidermidis, S. capitis is implicated with surface infections such as chronic blepharitis, suppurative keratitis, and purulent conjunctivitis [ 13 ].…”

Cataract Surgery by Intraoperative Surface Irrigation with 0.25% Povidone–Iodine

“…Although the etiology of this condition can be both endogenous and exogenous, it is mostly secondary to intraocular surgeries, injections or penetrating ocular trauma [16]. The incidence of endophthalmitis after cataract surgery is low with reports of 0.076% [17], 0.02% [18] and 0.048% [19]. Even with appropriate treatments, the final visual acuity is poor, and reported to be less than 20/200 (35.7%) or 20/200 to 20/40 (36.7%) [19].…”

“…Second step (Figure 4B): Even when the "border control" measure is taken, there is still a risk that bacteria on the ocular surface may enter the eye at the time of insertion of the intraocular lens. As a preventive measure, it is important to clean not only the anterior chamber but also the posterior surface of the intraocular lens after inserting the intraocular lens, in order to reduce the bacterial load [17,35]. The second measure is to thoroughly wash out the bacteria that have entered the anterior chamber.…”

“…Third step (Figure 4C): Even in cataract surgery performed without surgical complications, bacteria in the anterior chamber may flow into the vitreous body due to the increase in anterior chamber pressure during surgery [34]. The occurrence of complications including posterior capsule rupture, tear of zonule of Zinn and vitreous prolapse further increases the risk of migration of bacteria into the vitreous [17,19]. Since the bacteria in the vitreous cannot be removed by washing, there is no other way but to eliminate them by administering antibacterial drugs.…”

“…Since the bacteria in the vitreous cannot be removed by washing, there is no other way but to eliminate them by administering antibacterial drugs. The use of antibiotics varies depending on countries, institutions and surgeons, but not using postoperative antibiotics would increase the risk of endophthalmitis [17]. Many surgeons use intravenous or oral antibiotics to reduce the number of bacteria.…”