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M.W. Dorey, B.A. Ford, S.P. George; A Study of Postoperative Endophthalmitis in Halifax, Canada . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5570.
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Purpose: To study the incidence, clinical outcomes, and risk factors for endophthalmitis in patients undergoing cataract extraction with posterior chamber intraocular lens (PCIOL) implantation. Methods: Case series with clinical correlation. Retrospective analyses of 17438 cataract surgeries with PCIOL implantation at the Victoria General Hospital, Halifax, Canada from Jan 1, 1999 to Dec 31, 2003. Clinical and surgical features of all patients developing postoperative endophthalmitis were evaluated. Results: Thirty–six patients in our series developed endophthalmitis (0.206%). The mean age of our patients who developed endophthalmitis was 77 years (range=57–91). The mean duration of the surgery was 22 minutes (range=10–60 minutes). Temporal incision was used in 33 cases (92%) and clear cornea approach was used in 33 cases (92%). A nonfoldable lens was used in 22 cases (61%). Fourteen of our patients (39%) received intraoperative vancomycin. Vitreous was sent for cultures in all 36 cases (100%) and anterior chamber fluid was sent for cultures in 14 cases (39%). Thirty–five of our cases showed positive culture results (97%). Vitreous cultures yielded positive results in 33 cases (92%). Anterior chamber aspirate yielded positive results in four cases (11%) (Two of these patients showed negative vitreous culture results). Coagulase–negative staphylococcus was the most common agent identified (58%). The isolated organisms showed an increasing trend towards antibiotic resistance, particularly tobramycin. The mean vision of patients prior to cataract surgery was 20/70. The mean vision after treatment for endophthalmitis was 20/50. Twenty–one patients showed improved final vision and nine patients showed worsened final vision after medical and surgical management. Conclusions: Our study showed a higher incidence of postoperative endophthalmitis than what was described in previous studies. Factors that might increase the risk of postoperative endophthalmitis in patients undergoing cataract extraction and PCIOL implantation include nonfoldable lenses, temporal incisions and clear cornea approach. An anterior chamber aspirate may yield positive culture results when vitreous cultures are negative. The responsible organisms causing endophthalmitis showed increasing trends towards antibiotic resistance, particularly tobramycin. There was good visual recovery in many patients developing postoperative endophthalmitis after medical and surgical management. More studies are needed to properly evaluate this clinically important disease.
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