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M. Taban, A. Behrens, R.L. Newcomb, M.Y. Nobe, G. Saedi, P.M. Sweet, P.J. McDonnell; Incidence of Acute Endophthalmitis Following Cataract Surgery or Penetrating Keratoplasty: A Meta–Analysis . Invest. Ophthalmol. Vis. Sci. 2004;45(13):505.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To determine the incidence of acute endophthalmitis following cataract extraction (CE) or penetrating keratoplasty (PK) over time and explore possible contributing factors, such as type of cataract incision. Methods: A systematic review of English–language articles was conducted by performing a broad search–strategy of PUBMED from 1963 through March 2003 using such terms as CE, PK, endophthalmitis, and postoperative complication. Additional studies were identified from bibliographies of relevant articles, major ophthalmic textbooks, and published–proceedings. Articles were selected according to specific inclusion/exclusion criteria. Surgical approach for CE was recorded, when available. Pooled incidence rates and relative risk of developing endophthalmitis using different surgical techniques were assessed. Results: From 6,786 unique, potentially relevant citations, 281 original studies that addressed endophthalmitis and met the selection criteria were analyzed. A total of 3,140,650 CEs and 90,549 PKs were pooled from these studies. Overall, endophthalmitis was less common following CE (pooled estimate–0.1282%) than after PK (pooled estimate–0.3821%), (relative risk [RR], 0.34; 95% confidence interval [CI], 0.30–0.37). However, the incidence of acute endophthalmitis after CE changed over time, with a significant increase in endophthalmitis rate since year 2000 compared to previous decades (RR, 2.44; 95% CI, 2.27–2.61). The rates of endophthalmitis following CE and PK were, respectively, 0.2652% and 0.1997% in the 2000–2003 period, 0.0866% and 0.4527% in 1990s, 0.1578% and 0.3758% in 1980s, and 0.3267% and 0.1424% during the 1970s. For CE, an upward trend in rates after year 1992 was noted, compared to 1991 and prior. In contrast, a downward trend in the incidence of endophthalmitis after PK occurred since 1992. Incision type appeared to significantly influence risk, as endophthalmitis following clear corneal CE during the 1992–2003 period was 0.1885% compared to 0.0737% (RR, 2.55; 95% CI, 1.75–3.71) for scleral incision and 0.0620% (RR, 3.06; 95% CI, 2.48–3.76) for limbal incision. Conclusions: This meta–analysis indicates that the incidence of endophthalmitis associated with CE has increased over the last decade, whereas a decline has been observed with PK. This upward trend in endophthalmitis frequency coincides temporally with the development of sutureless clear corneal incisions.
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