The Latest Updates and Management of Endophthalmitis

Abstract

P ostoperative endophthalmitis (PE), although rare, is undoubtedly the most serious complication in ocular surgery, with less than half of the affected patients able to achieve a final visual acuity of 20/40 or better. 1 The highest risk is observed in cataract surgery with intraocular lens (IOL) implantation and the lowest in pars plana vitrectomy (PPV). 2 Recent estimates of the rate of endophthalmitis after cataract surgery have ranged between 0.08% and 0.68%. 3 In this editorial, we will review the latest information related to the respective roles of disinfection using povidone-iodine (PVI) before surgery and the use of preoperative, intracameral, and postoperative antibiotics in the prevention of PE. Latest developments in management of endophthalmitis will also be discussed.The European Society of Cataract and Refractive Surgeons (ESCRS), in its first randomized multicenter study on antimicrobial prophylaxis, reported an incidence of endophthalmitis ranging from 0.049% to as high as 0.345% in the control group. 4 The preferred practice pattern for prophylaxis of endophthalmitis has seen some major crests and troughs in recent periods, as the ESCRS group failed to reduce the rate of PE (0.074%) significantly less than expected, despite using intracameral cefuroxime in the study population. 5 The usual concentration of PVI used before cataract surgery is between 5% and 10%, with an exposure time of 2 to 5 minutes. There has been a trend toward irrigating and applying PVI on the ocular surface for a contact period of at least 5 minutes before cataract surgery to reduce the risk of PE. Although there may be multiple factors, the application of PVI to the ocular adnexa and conjunctival surface is probably the single most determining factor in reducing the risk of PE after cataract surgeries. 6 Although in vitro studies have shown a bactericidal effect of PVI even at 30 seconds, we still believe that these variable and inconsistent PVI regimens are most likely responsible for the more than expected incidence of endophthalmitis after cataract surgery and intravitreal injections. To date, there is no report of bacterial resistance against PVI as compared with antibiotics. 7 Application of 10% PVI to the eyelids and periorbital area and 5% PVI on the ocular surface resulting in exposure for 5 minutes can prevent the growth of most postcataract surgery endophthalmitis bacterial isolates. Although there is no large randomized study to support the addition of topical antibiotics preoperatively or postoperatively to reduce the rate of postcataract surgery or intravitreal injection endophthalmitis, the practice is widely prevalent in most clinical settings. 8 The study by Miller et al 9 has been referred to in several published works stating that lidocaine gel may increase the risk of acute postoperative endophthalmitis as it was thought to act as a barrier to asepsis. However, a report by Lad et al 10 showed little effect of lignocaine gel on asepsis. We support the use of additional PVI before and after the applicatio...

Endoftalmitis Pasca Operasi Katarak

“…dalam mata. Kondisi ini menimbulkan gambaran klinis dan penanganan yang berbeda dengan endoftalmitis pasca operasi katarak (1,2).…”

“…Semua pasien yang menjalani operasi katarak harus dievaluasi untuk setiap faktor risiko potensial yang dapat meningkatkan perkembangan endoftalmitis pasca operasi; mengelola risiko intraoperatif dan protokol profilaksis harus dipertimbangkan untuk mengurangi risiko endoftalmitis. Tindak lanjut dini setelah operasi katarak sangat dianjurkan untuk mendeteksi tandatanda endophthalmitis sehingga dapat segera diobati dan memastikan kepatuhan pasien pada pengobatan pasca operasi dan tindakan pencegahan untuk mengurangi komplikasi serius yang disebabkan oleh keterlambatan diagnosis dan pengobatan endophthalmitis pasca katarak (1,2).…”