Presumed infectious endophthalmitis following cataract surgery in the UK: a case–control study of risk factors

Abstract

Aims To study risk factors for presumed infectious endophthalmitis complicating cataract surgery in the United Kingdom. Methods Two hundred and fourteen clinically diagnosed patients with presumed infectious endophthalmitis were compared with 445 control patients throughout the United Kingdom in a prospective case-control study. The cases were identified through the British Ophthalmological Surveillance Unit reporting card system. Control patients undergoing cataract surgery from 13 'control centres' throughout the United Kingdom were selected randomly. Risk factors were identified by univariate and multivariate logistic regression analyses. Pertinent variables relating to the cataract extraction procedure, antimicrobial prophylaxis, ophthalmic and medical history were analysed with regard to postoperative infection. Results Statistically significant risk factors in the multivariate model included inpatient cataract surgery (P ¼ 0.001), surgery in dedicated eye theatres (Po0.001), consultant grade surgeon (compared to registrar) (P ¼ 0.001), posterior capsule tear during cataract surgery (P ¼ 0.001). The use of face masks by the scrub nurse and surgeon during cataract surgery (Po0.001) and the administration of subconjunctival antibiotics at the end of surgery (Po0.001) were protective against postoperative infection. Conclusions In order to minimise the risk of postoperative endophthalmitis we would recommend the wearing of face masks by the surgeon and scrub nurse during cataract surgery and subconjunctival antibiotics at the end of surgery.

Reply to Bhavsar et al

“…This method has been reported in the literature. 5 As acknowledged, we discussed the reasoning for not including data on the use of povidone-iodine in our manuscript. 2 It was in fact the BOSU committee who recommended that we did not include this in our questionnaire as part of the strict, independent, peer review process.…”

Post-intravitreal anti-VEGF endophthalmitis in the United Kingdom: incidence, features, risk factors, and outcomes

“…Forty-six PIAE cases followed intravitreal Ranibizumab (Lucentis, Novartis Pharmaceuticals) and one following intravitreal Bevacizumab (Avastin, proprietary, off label use). Of these, the majority of injections were performed in a clean room (38). Eight were performed in theatre and one in the outpatient clinic.…”

“…[38][39][40] While modern cataract surgery has been performed for several decades, the use of intravitreal anti-VEGF has only been used in regular practice for about 6 years. As a result, our understanding of risk factors for PIAE are comparatively limited.…”

Pathogenic conjunctival bacteria associated with systemic co-morbidities of patients undergoing cataract surgery

“…[1][2][3][4][5][6][7][8][9][10] Apart from the risk due to surgical complication such as the capsular posterior rupture, 4,5,7,11,12 other PE risks have occasionally been described, for instance diabetes 13,14 and immunosuppression. 15 The magnitude of the men as a group at risk, the imprecision of the age factor, the low incidence of PE, and our previous finding of a higher prevalence of certain pathogenic conjunctival bacteria in diabetics undergoing cataract operation 16 suggest the hypothesis of patients having other concomitant characteristics partially responsible for the increased PE incidence of men and older patients, which could imply more reduced subgroups of patients at risk.…”