A 10 year retrospective survey of cataract surgery and endophthalmitis in a single eye unit: injectable lenses lower the incidence of endophthalmitis

Mayer, Eric; Cadman, D; Ewings, Paul; Twomey, J M; Gray, Roger; Claridge, K G; Hakin, K N; Bates, A K

doi:10.1136/bjo.87.7.867

Cited by 75 publications

(67 citation statements)

References 21 publications

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“…The rate of recovery depends on the clinical settings, method of specimen collection and inoculation, load of viable microbes in the inoculum, previous medical therapy, and the environment in which the inoculated plates are incubated. [17][18][19] In this study, 100% recovery rate achieved in endophthalmitis following corneal and scleral infections, whereas it accounted for 65% in post-traumatic (141 of 217), 36% in post-surgical (225 of 625), and 15.5% in EE (11 of 71). In comparison, higher recovery rates are documented in many studies from postoperative endophthalmitis (67% in EVS, 9,16 53% in South India, 20 60% in Canada, 21 67% in Australia, 22 and 75% in Sweden 23 ).…”

Section: Discussionmentioning

confidence: 99%

Microbiological profile of culture-proven cases of exogenous and endogenous endophthalmitis: a 10-year retrospective study

Ramakrishnan

Bharathi

Shivkumar

et al. 2008

Eye

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Purpose To identify the microbial aetiology of infectious endophthalmitis and to determine the in vitro antibacterial susceptibilities of bacterial isolates. Methods A retrospective analysis was carried out of all patients presenting between January 1997 and December 2006 with clinically diagnosed infectious endophthalmitis who underwent microbiological evaluation. Intraocular specimens (aqueous and vitreous fluids) were collected from all cases of clinically suspected infectious endophthalmitis. In addition to intraocular aspirates, blood specimens from endogenous endophthalmitis, and corneal and scleral scrapes from relevant cases were also collected. The collected intraocular specimens, blood specimens, and corneal and scleral scrapes were subjected to microbiological evaluation. Results Samples from 955 patients with endophthalmitis underwent microbiological analysis, of which 424 (44.4%) were found to be culture positive. Of 424, 364 (85.8%) had bacterial growth and the remaining 60 (14.2%) had fungal growth. Among post-surgical endophthalmitis, Gram-negative bacilli (75%) were found to be the predominant cause for developing fulminant onset, Staphylococcus spp. (68.6%) for acute, and Streptococcus spp. (75%) for chronic onset of infections, whereas in post-traumatic endophthalmitis, Gramnegative bacilli (65.2%) were found to be the predominant cause for fulminant onset, Gram-positive bacillus (28.4%) for acute onset, and fungi (52.3%) for chronic onset of infections. Endophthalmitis associated with microbial keratitis was mainly caused by filamentous fungi (37.2%) and Gram-negative bacilli (37.2%). Overall, gatifloxacin (97.7%) showed highest activity against bacterial isolates followed by ciprofloxacin (95.9%) and ofloxacin (95.1%). Conclusion Gram-negative bacilli cause predominantly fulminant onset, Staphylococci and Gram-positive bacilli acute, and Streptococci, Nocardia, and fungi chronic endophthalmitis. Gatifloxacin demonstrated greatest efficacy against these bacterial isolates.

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Section: Discussionmentioning

confidence: 99%

Microbiological profile of culture-proven cases of exogenous and endogenous endophthalmitis: a 10-year retrospective study

Ramakrishnan

Bharathi

Shivkumar

et al. 2008

Eye

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“…This suggests that surgical incision size positively correlates with the probability of pathogenic bacteria entering the eye (Mayer et al, 2003). Additionally, some investigators have reported an elevated incidence of endophthalmitis by more than 300% when a scleral tunnel incision was replaced with a transparent corneal incision during cataract surgery.…”

Section: Discussionmentioning

confidence: 96%

Clinical features and treatment of endophthalmitis after cataract surgery

Zhu

2015

Genet. Mol. Res.

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ABSTRACT. The aim of this study was to investigate the clinical features and treatment results of endophthalmitis after cataract surgery. Five patients with endophthalmitis after phacoemulsification with intraocular lens implantation were enrolled in this study. The pathogenesis, clinical manifestation, and surgical outcomes of 5 patients were compared. Three patients were surgically treated with anterior chamber irrigation and vitrectomy with intravitreal injection. The remaining two patients were medically treated with an intravitreal injection of vancomycin and ceftazidime. Treatment results of the five patients were analyzed. Four patients had positive cultures for bacteria (two cases Staphylococcus epidermidis, one case Enterococcus faecalis, and one case head-like Staphylococcus). The culture of the fifth patient did not have bacterial growth. One year following treatment, four patients had restored visual acuity and a clear vitreous cavity. Retinal detachment and other complications were not observed. The remaining patient had a visual acuity of index at 30 cm one year following treatment. For patients with endophthalmitis after cataract surgery, a biochemical laboratory examination should be promptly performed and should include a bacterial culture and drug sensitivity test. When necessary, vitrectomy combined with an intravitreal injection of vancomycin should be performed to treat the infection early and to help retain useful vision.

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“…28 It is postulated that this may be due to the injector preventing the lens from making contact with the ocular surface during insertion. Injectors, although available, are not routinely used in our department and were not used in any of the POE cases.…”

Section: Determining the Cause Of The Outbreakmentioning

confidence: 99%

A model for the management of an atypical endophthalmitis outbreak

Anderson

Lee

Shafi

et al. 2004

Eye

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Purpose of study To present a model for the assessment, investigation, and management of an atypical outbreak of infectious endophthalmitis of indeterminate aetiology. Methods A published statistical model was used to determine when the case-load constituted an outbreak. Intraocular surgery was discontinued and a multidisciplinary infection control team was formed aimed at identifying potential causative factors among the following categories: environment around theatre, preoperative preparation, intraoperative theatre practices, intraoperative surgical practices, postoperative practices, equipment maintenance guidelines, cleaning/ sterilization practices, and microbiological screening. Results Five cases of postoperative endophthalmitis developed following uncomplicated phacoemulsification cataract surgery by different surgeons over a 7-month period. Despite full investigation no single focus of infection could be determined. Four out of five cases were culture positive. Three grew Streptococcus viridans of different strains. The fourth culture grew Staphylococcus aureus. In the absence of a single causative factor, it was postulated the combined effect of multiple potential factors may have led to an increased bacterial load and subsequent infection rate. Improved practices were initiated including new cleaning protocols to combat the build-up of debris on phacoemulsification instruments. Cataract surgery was resumed with 3-monthly microbiological monitoring. There have been no further cases in the 12 months following the changes. ConclusionOutbreaks of endophthalmitis typically present over a short time period and could often be attributed to a single infective cause. We present our experience of detecting and managing this cluster and recommend a 'ground-up' multidisciplinary model to manage future outbreaks of this devastating condition.

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A 10 year retrospective survey of cataract surgery and endophthalmitis in a single eye unit: injectable lenses lower the incidence of endophthalmitis

Cited by 75 publications

References 21 publications

Microbiological profile of culture-proven cases of exogenous and endogenous endophthalmitis: a 10-year retrospective study

Microbiological profile of culture-proven cases of exogenous and endogenous endophthalmitis: a 10-year retrospective study

Clinical features and treatment of endophthalmitis after cataract surgery

A model for the management of an atypical endophthalmitis outbreak

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