How to prevent endophthalmitis in cataract surgeries?

Abstract

Postoperative endophthalmitis is a very devastating complication and every step should be taken to reduce its occurrence. Unattended air conditioning filter systems are often the culprits and regular maintenance of the filters is of paramount importance. Shedders of pathogenic organisms amongst the theater personnel should be identified by regular screening and should be promptly treated. In addition to the use of Povidone iodine 5% solution in the conjunctival sac few minutes prior to surgery, proper construction of wound, injectable intraocular lenses, use of prophylactic intracameral antibiotics or prophylactic subconjunctival antibiotic injection at the conclusion of cataract surgery, placing a patch after the surgery for at least 4 h and initiating topical antibiotics from the same day of surgery helps to lower the frequency of postoperative endophthalmitis. Intraoperative posterior capsule rupture and anterior vitrectomy are risk factors for acute endophthalmitis, and utmost care to prevent posterior capsular rent should be taken while performing cataract surgery. Also, in case of such complication, these patients should be closely monitored for early signs of endophthalmitis in the postoperative period. In the unfortunate event of endophthalmitis the diagnosis should be prompt and treatment must be initiated as early as possible.

One-year visual outcomes and patient satisfaction after surgical correction of presbyopia with an intracorneal inlay of a new design

“…The surgical procedure is not intraocular, as for multifocal intraocular lens implantation, which may have potential intraocular complications. 15 Two studies 11,12 report the results of implantation of the previous-generation inlay after creation of a laser in situ keratomileusis (LASIK) flap. The flap was consecutively repositioned after the inlay was inserted in the stromal bed precisely over the line of sight.…”

The journey to femtosecond laser-assisted cataract surgery: new beginnings or a false dawn?

“…Furthermore, the risk of endophthalmitis is thought to increase every time an instrument is introduced into the eye. 52 Laboratory and animal studies have shown that ultrasound power within the anterior chamber causes oxidative stress and cellular injury, with the production of free radicals that are toxic to the corneal endothelium. 53,54 However, the magnitude of this cellular damage in vivo with modern phacoemulsification techniques is uncertain, so its clinical relevance remains unclear.…”

Impact of Changes in Antibiotic Prophylaxis on Postoperative Endophthalmitis in a Spanish Hospital

“…1 In the majority of cases, the source of the bacteria involved is the patient's own periocular flora, 2,3 although exogenous sources such as the conditions of the operating room 4,5 or its personnel may also be responsible. 4,6 The purpose of antibiotic prophylaxis in eye surgery is both to reduce the amount of microbial flora on the ocular surface before surgical intervention, 7 as well as to prevent any flora that manages to survive from reaching an inoculum capable of permitting the development of infection. Despite the fact that the prophylactic administration of antibiotics in ophthalmology is controversial, its use is widespread, although the most effective and appropriate regimen has yet to be established.…”