A literature review and update on the incidence and microbiology spectrum of postcataract surgery endophthalmitis over past two decades in India

Abstract

Purpose:The purpose of this study was to review the incidence and microbiology of acute postcataract surgery endophthalmitis in India.Methods:Systematic review of English-language PubMed referenced articles on endophthalmitis in India published in the past 21 years (January 1992–December 2012), and retrospective chart review of 2 major eye care facilities in India in the past 5 years (January 2010–December 2014) were done. The incidence data were collected from articles that described “in-house” endophthalmitis and the microbiology data were collected from all articles. Both incidence and microbiological data of endophthalmitis were collected from two large eye care facilities. Case reports were excluded, except for the articles on cluster infection.Results:Six of 99 published articles reported the incidence of “in-house” acute postcataract surgery endophthalmitis, 8 articles reported the microbiology spectrum, and 11 articles described cluster infection. The clinical endophthalmitis incidence was between 0.04% and 0.15%. In two large eye care facilities, the clinical endophthalmitis incidence was 0.08% and 0.16%; the culture proven endophthalmitis was 0.02% and 0.08%. Gram-positive cocci (44%-64.8%; commonly, Staphylococcus species), and Gram-negative bacilli (26.2%–43%; commonly Pseudomonas species) were common bacteria in south India. Fungi (16.7%-70%; commonly Aspergillus flavus) were the common organisms in north India. Pseudomonas aeruginosa (73.3%) was the major organism in cluster infections.Conclusions:The incidence of postcataract surgery clinical endophthalmitis in India is nearly similar to the world literature. There is a regional difference in microbiological spectrum. A registry with regular and uniform national reporting will help formulate region specific management guidelines.

Antibiotic prophylaxis practice patterns for cataract surgery in India – Results from an online survey

“…recent review reported that endophthalmitis rates in India have ranged between 0.04%–0.15% during the past two decades. [ 13 ] This is in line with other reported rates internationally,[ 6 15 16 17 ] but based on the extremely high-volume of cataract surgery performed in India, Lalitha et al . estimated that there may be as many as 4800 Indian endophthalmitis cases annually.…”

“…There are currently more than 15,000 active cataract surgeons in India who perform approximately 6 million cataract surgeries annually. [ 13 ] In contrast to the West, manual small incision extracapsular cataract surgery (MSICS) accounts for a higher percentage of procedures in India due to a greater prevalence of indigent patients. Another important difference in India is the commercial availability of single-use IC moxifloxacin formulations (Auromox, Aurolab, India and 4-Quin, Entod pharmaceuticals, India).…”

Penicillium on the Iris! An Unusual Presentation and Cause of Postoperative Anterior Uveitis

“…Postoperative fungal infections of the eye have been reported to present as endogenous endophthalmitis with an incidence ranging from 16.7% to 70% [1][2]. Endogenous endophthalmitis occurs especially in patients with drug-induced immunosuppression, organ transplantation, or a nidus for infection such as an indwelling catheter.…”

Recommendations for an expert team investigating a case of cluster endophthalmitis

“…[ 6 7 8 ] Cluster endophthalmitis cases are generally exogenous in origin and are described in association with various solutions/fluids used during surgery such as internal fluid pathways of phacoemulsifier, irrigating solutions, viscoelastic substances, intracameral injections, and with drops/drug solutions used in perioperative period. [ 9 10 11 ] They can also occur due to breach in the sterilization or aseptic protocols. Loss of sight in one eye has a profound impact on the patient's life, their social well-being, and possibly their profession.…”