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Cecilia S Lee, Ester Carreno, Guillermo Fernandez Sanz, Aaron Y Lee, Christina Nemeth, Catherine Cook, RIckin Dattani, Richard W J Lee, Carlos E Pavesio; Increased Risk of Post-Cataract Endophthalmitis in Uveitis Patients - A Retrospective 10 Year Study. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3847.
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To compare the rate of endophthalmitis after cataract extraction (CE) in uveitic vs. non-uveitic patients.
A retrospective chart review was conducted of all patients diagnosed with endophthalmitis following CE at Moorfields Eye Hospital from 1/2003 to 12/2012. Demographics and relevant medical/ocular history were reviewed. Intraoperative variables, final visual acuity (VA), and the odds risk ratio for endophthalmitis in patients with uveitis were analyzed.
134,077 patients underwent CE, and of these 642 (0.48%) had a history of uveitis. Seven (1.09%) of the uveitis patients developed post-operative endophthalmitis compared with 51 (0.04%) patients in the non-uveitis group (odds ratio 27; 95% CI: 10.4 to 60.3; p-value = 1.95e-8 by Fisher’s Exact Test). There was no difference in VA at presentation with endophthalmitis (2.15 vs. 2.44); however, the VA after 1 year was significantly better in uveitis patients (0.39 vs. 0.90, p-value=0.02). On average, the uveitis patients who developed post-operative endophthalmitis were younger than their non-uveitic counterparts (mean age = 58.3 vs 70.3 years). Preoperative VA and the frequency of intraoperative complications were similar in both groups (Table 1). A total of 51 vitreous taps and one anterior paracentesis were performed. Nineteen out of 51 (37%) were culture positive in the non-uveitis group vs. 1 out of 6 (17%) in the uveitis group. Of the cultured organisms in the non-uveitis group, there were 4 Pseudomonas (21%), 9 Staphylococcus (47%), 5 Streptococcus (26%), 1 Serratia (5%) infections. The organism detected in the uveitis patient was Haemophilus.
There was a 27 times greater risk of post-operative endophthalmitis after cataract surgery in patients with uveitis; however, the majority of cases could have been severe postop inflammations rather than true culture negative endophthalmitis given low rate of culture positivity, early presentation following the surgery, and better visual outcome. This large cohort provides a reference dataset for the comparative risk of post-operative endophthalmitis in patients with uveitis, which can be used both to counsel patients and inform future studies.
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