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

The antibiotic resistance pattern of conjunctival bacteria: a key for designing a cataract surgery prophylaxis

“…27,28 These bacteria produced a relatively high PE incidence in the important Swedish series 5 without using levofloxacine at any time nor any postoperative prophylaxis, but not in the ESCRS study 8 using topical postoperative levofloxacine (although whether these bacteria colonised the conjunctiva of patients operated on in the ESCRS study 8 is a question that remains unclear because of the study exclusion criteria 10 of their patients). Also, in recent American PE series, 29 Enterococci and Gram-negative rods were not isolated among their PE cases, and they used topical new quinolones as prophylaxis.…”

“…On the other hand, taking into account our results and the need to use two different antibiotics, and according to other cataract surgery prophylaxis experiences outside Europe, 18,[29][30][31][32] it would be useful to investigate our conjunctival bacteria resistance to moxifloxacine in the near future. This antibiotic seems to have the best pharmacologic and pharmacodynamic properties 18 and reduces the PE incidence to the levels as low as those achieved using intracameral cefuroxime, even when moxifloxacine was used topically.…”

“…This antibiotic seems to have the best pharmacologic and pharmacodynamic properties 18 and reduces the PE incidence to the levels as low as those achieved using intracameral cefuroxime, even when moxifloxacine was used topically. [29][30][31][32] Nevertheless, moxifloxacine resistance has appeared in America, causing acute PE cases, 24,30 which, besides the concerns regarding intracameral antibiotics, has addressed the need for a multipronged approach to limit the endophthalmitis risk, with antibiotics as only part of the strategy. 24 In this way and consistent with our results, it would be interesting to identify any clinical characteristic of the approximately 5% of patients harbouring The cataract surgery prophylaxis target E Ferná ndez-Rubio et al…”

Bilateral paediatric cataract surgery in the same session

“…Additionally, a younger child in an amblyopia-susceptible period with bilateral significant cataract should have two consecutive surgeries with the shortest possible interval such as a few days, whereas this brief period cannot guarantee for eliminating the risk of bilateral acute-onset endophthalmitis that may not be diagnosed up to 21 days postoperatively. 16 Although there is no objective reason to assume an increased risk of endophthalmitis following the simultaneous approach in light of evidences, and since prophylactic intracameral antibiotic use can also markedly reduce the incidence of endophthalmitis, 12 paediatric patients at a high risk of endophthalmitis (such as infections of ocular surface and adnexia, upper respiratory tract infection, and immunosuppression) should be excluded from the simultaneous bilateral cataract surgery, strict surgical aseptic guidelines should be followed in the operating room, and finally each eye should be treated as a completely separate procedure to minimize the risk of endophthalmitis. Conversely, considering the possibility of clusters of endophthalmitis cases due to contaminated operating room air, intraocular irrigation fluids, or water used to rinse instruments, BPCS in the same session should be considered in selected cases regarding the risk of general anaesthesia and amblyopia, the patient and family compliance, and reserved for modern operating theatres in case of strict surgical aseptic conditions preserved for each eye separately.…”

Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery.

“…At that rate and assuming an incidence of one case per thousand surgeries, 30,000 cases of post-cataract surgery endophthalmitis would occur annually, with roughly 10,000 leading to blindness in the operated eye. Visual recovery following acute postoperative endophthalmitis remains poor across different clinical settings, despite advances in treatment (Lalitha 2005;Miller 2005;Ng 2005;Sheng 2011). The extensive use of surgery to provide better vision for people with cataracts across the world calls for adoption of evidence-based methods to prevent acute endophthalmitis.…”