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Jonathan Kam, Rosie Dawkins, Danielle Buck, Sukhpal Sandhu, Penelope Allen; Changing patterns of endophthalmitis at a state-wide service in Australia over a 14 year period. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3174.
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Over the past decade, several major changes in ophthalmological practice may have had an impact on patterns of endophthalmitis. For example, the use of intracameral antibiotics in cataract surgery, and the introduction of intravitreal anti-VEGF injections. The purpose of this study was to evaluate for any change in patterns of endophthalmitis over a 14 year period at one institution that may call for alteration of current prophylaxis or treatment guidelines.
A prospective consecutive case series was collected of patients with presumed endophthalmitis from July 1997 to June 2011 at the Royal Victorian Eye and Ear Hospital. Data included precipitating factor, visual acuity, microbial profiles, and vitrectomy rate. Cases from the first 7 years were compared to cases from the latter 7 years. In addition, a survey of prophylactic antibiotic use by ophthalmologists in Victoria, Australia, for preventing post-operative endophthalmitis was carried out.
There were 802 cases of endophthalmitis included in this study, 409 (51.0%) in the first 7 years, and 391 (49.0%) in the latter 7 years. In the first 7 years, there were 251 (61.4%) cases related to cataract surgery as compared to 163 cases (41.5%) in the latter 7 years (p=0.0001). There were 49 (12.0%) vs 28 (7.1%) related to glaucoma surgery, 31 (7.6%) vs 19 (4.8%) post penetrating eye injury, 25 (6.1%) vs 30 (7.6%) with corneal ulceration, 30 (7.3%) vs 74 (18.8%) from an endogenous source (p=0.0001), 7 (1.7%) vs 17 (4.3%) post vitreo-retinal surgery, and 1 (0.2%) vs 37 (9.4%) from intravitreal injection (p=0.0001).The most commonly cultured organisms in cataract surgery related cases were S. epidermidis (27.5% vs 19.8%, p=0.178), S. aureus (18.6% vs 13.8%) and coagulase-negative staphylococcus (17.4% vs 19.0%). Routine use of intracameral cefazolin with cataract surgery increased from 6.3% in 2004 to 78.1% in 2011.
There has been a reduction in cataract and glaucoma surgery related endophthalmitis, and an increase in intravitreal injection related, vitreo-retinal surgery related and endogenous endophthalmitis. The uptake of intracameral cefazolin has not significantly changed the microbial spectrum of cataract related endophthalmitis, and thus remains appropriate prophylaxis. Ophthalmic surgery and injections remain important targets for practice improvement to reduce the burden of this important iatrogenic disease.
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