Incidence of Acute Postoperative Endophthalmitis after Cataract Surgery

Creuzot‐Garcher, Catherine; Benzenine, Éric; Mariet, Anne‐Sophie; Lazzer, Aurélie de; Chiquet, Christophe; Bron, Alain M.; Quantin, Catherine

doi:10.1016/j.ophtha.2016.02.019

Cited by 133 publications

(121 citation statements)

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“…More recently, 2 papers assessed endophthalmitis after cataract surgery. The first found a decrease in endophthalmitis after cataract surgery from 2005 to 2014 and, within the same period, an increased use of intracameral antibiotics [24] . The second observed that with perioperative capsular rupture of the lens, the incidence of endophthalmitis was lower for patients with than without an intracameral injection of antibiotics, with no increased risk of cystoid macular edema [25] .…”

Section: Episafe Collaborative Program In Cataract Surgerymentioning

confidence: 96%

“…In addition, the statistical power to assess the safety of drugs is often lacking in RCTs because side [23] . Using French medical-administrative databases and high statistical power, the EPISAFE collaborative program aims to further explore the safety of drugs and interventions, as we did recently for endophthalmitis after cataract surgery [24,25] . The EPISAFE collaborative group has regular meetings to coordinate research projects.…”

Section: Episafe Collaborative Programmentioning

confidence: 99%

“…The date of death is valuable information recorded since 2008, and the cause of death was also retrieved in a previous study [36] . The SNIIR-AM is a useful data source to estimate the incidence and prevalence of rare diseases or complications such as postoperative endophthalmitis [24,25] . Mother-to-child studies are possible since this linkage was set up in 2012.…”

Section: In Epidemiologymentioning

confidence: 99%

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French Medical-Administrative Database for Epidemiology and Safety in Ophthalmology (EPISAFE): The EPISAFE Collaboration Program in Cataract Surgery

Daïen¹,

Korobelnik²,

Delcourt

et al. 2017

Ophthalmic Res

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Medical-administrative databases are an important source of big data to assess the epidemiology of diseases and interventions, compare drugs, and investigate rare adverse events. We describe the French national health insurance system databases and the Epidemiology and Safety (EPISAFE) collaboration program in ophthalmology and illustrate the paper with recent studies that used the databases to investigate cataract surgery. The Système national d'information inter-régime de l'assurance maladie (SNIIR-AM) is one of the largest databases of medical and administrative data for a general population, covering nearly 65 million people. The SNIIR-AM database links data for all outpatient-reimbursed health expenditures, hospitalization in all 1,546 French private or public healthcare facilities, and date of death. The use of this database provides information at the scale of the entire country, allowing measurement of the impact of changes in practices and new guidelines. Between 2009 and 2012, a total of 2,717,203 eyes in 1,817,865 patients underwent cataract surgery in France, and the incidence of cataract surgery increased from 9.86 to 11.08/1,000 person-years. The 4-year cumulative risk of retinal detachment was 0.99%, and patients <60 years of age were at higher risk of retinal detachment. The incidence of pseudophakic cystoid macular edema was 0.95%. From 2005 to 2014, from data including more than 6 million procedures, the incidence of endophthalmitis after cataract surgery decreased from 0.15 to 0.05%. The EPISAFE collaboration program encompasses the key issues facing ophthalmology, including public health and public policy concerning disease incidence and prevalence, safety and adverse event monitoring, and clinical guidelines.

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Section: Episafe Collaborative Program In Cataract Surgerymentioning

confidence: 96%

Section: Episafe Collaborative Programmentioning

confidence: 99%

Section: In Epidemiologymentioning

confidence: 99%

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French Medical-Administrative Database for Epidemiology and Safety in Ophthalmology (EPISAFE): The EPISAFE Collaboration Program in Cataract Surgery

Daïen¹,

Korobelnik²,

Delcourt

et al. 2017

Ophthalmic Res

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“…Bacteria responsible for endophthalmitis commonly originate from a patient's lids and lashes [1][2][3]. The goal when applying an eye surgical drape is to isolate the lids, lid margins, and eyelashes from the surgical field [4,5] to reduce the incidence of infection.…”

Section: Short Communicationmentioning

confidence: 99%

Application of Eye Surgical Drape to Decrease the Risk of a Corneal Abrasion

2017

J Eye Cataract Surg

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A corneal abrasion is a risk when applying an eye surgical drape. A new technique is discussed that decreases the risk of corneal injury. A corneal abrasion at the time of intraocular surgery may reduce visibility for the surgeon resulting in an increased risk of an intraocular complication, greater patient postoperative discomfort, and a delayed visual outcome. Keywords: Corneal abrasion; Endophthalmitis; Surgical drape Short CommunicationProper application of an eye surgical drape is an important step to prevent endophthalmitis at the time of intraocular surgery. Bacteria responsible for endophthalmitis commonly originate from a patient's lids and lashes [1][2][3]. The goal when applying an eye surgical drape is to isolate the lids, lid margins, and eyelashes from the surgical field [4,5] to reduce the incidence of infection.A corneal abrasion or loosening of the epithelial cells is a potential complication when applying a surgical drape. This can make the surgical procedure significantly more difficult to perform if visibility of the intraocular structures is reduced. In addition, patients with a corneal abrasion will be more uncomfortable in the early postoperative period and visual recovery can be delayed. Surgical textbooks go in to great detail about intraocular techniques but usually omit techniques of applying a surgical drape. I would like to describe a simple new technique of applying an eye surgical drape that can be successful in isolating the eye in the surgical field and result in a low incidence of a corneal epithelial defect.It is important to recognize that the glue from a surgical drape is to adhere to the lid and periorbita area and not the cornea or conjunctiva. The clear plastic from the drape can cause a corneal abrasion if significant pressure is applied over the cornea. Patients with epithelial basement membrane dystrophy are more prone to corneal epithelial defects [6]. Rather than apply drape pressure directly over an eye, a drape can be applied temporally to decrease the risk of a corneal abrasion.The technique is to fold the surgical eye drape in half and then instruct the patient to open their lids and gaze to the left in the case of the right eye or gaze to the right in the case of the left eye. A dry surgical spear can be used to open the lids near the lateral canthal area (Figure 1), and then the drape can be applied asserting pressure only temporally (Figure 2) and angled in line with the temporal bone.

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“…During this timeframe, the use of intracameral antibiotics increased from 0.60% to 80.03%, and the investigators concluded that the intracameral antibiotics were responsible for these outcomes. 2 These results are intriguing and illustrate the power of "Big Data" medical record analyses. However, as the authors acknowledge, all "Big Data" studies are limited by their retrospective nature and potential inaccuracies in diagnosis and procedure coding.…”

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confidence: 95%