Postoperative Endophthalmitis: Incidence and Isolated Microorganisms - A 21-Years Review

Abstract

 

Purpose:

 

To determine the incidence of postoperative endophthalmitis (POE) at the Department of Ophthalmology, Ludwig-Maximilian University, Munich, Germany over the past 21 years.

 

Methods:

 

Medical records of all in-patients with clinically diagnosed POE after surgery at our hospital between Jan. 1990 and Oct. 2010 were reviewed after IRB consent. Due to changes in the preoperative prophylaxis [antibiotics and povidone-iodine (PVI)], the patients were divided into 3 groups for data analysis: Group I (1990-1993, n=7.164) periorbital scrub with 10% PVI only, Group II (1995-1998, n=17.754) using 1 drop PVI 1% on the conjunctiva and Group III (1999-2010 n=47.312) flush-irrigation of the conjunctival sac with 10ml PVI 1%.

 

Results:

 

In 72.230 in-patients with intraocular surgeries 79 cases of POE occurred [41 females, 38 males, median age 75 years (range 1-94 years)]. The primary surgery before POE in these patients was: CE/IOL=29, CE/IOL/ppV=15, ppV=16, trabeculectomy=4, keratoplasty=4, other intraocular surgeries=11. The incidence of POE in the three groups was: 0.26% in Group I (n=19/7.164), 0.18% in Group II (n=32/17.754) and 0.063% in group III (n=30/47.312) (Figure 1).The isolated microorganism (58/80 cases) were: 28 Coagulase Negative Staphylococcus (CNS), 16 Staphylococcus aureus, 10 Streptococci, 3 Gram negative rods and 1 fungus. In 15 specimens the culture was sterile, in 7 cases no specimens were obtained. In figure 1, the numbers of surgeries as well as the incidence of POE [%] are shown for each year until Oct. 2010.

 

Conclusions:

 

Over the years the incidence of POE decreased with modifications in the preoperative prophylaxis and surgery techniques. CNS was most commonly identified in POE, while the spectrum of microorganisms did not show a significant trend over the years.  

 

Keywords: endophthalmitis • bacterial disease