Endophthalmitis following cataract surgery in Sweden.The 1998 national prospective survey

Abstract

ABSTRACT.Purpose: To investigate the morbidity of postoperative endophthalmitis (POE) following cataract surgery in Sweden in 1998. Methods: Clinically presumed cases of POE were reported in a prospective survey in which all Swedish ophthalmic surgical units except one had agreed to participate. Data on intraocular cultures and visual outcomes at 3 months after infection were supplied. Surgical cases that became infected were identified in the Swedish National Cataract Register, thereby enabling screening for various putative risk factors. Results: The nationwide incidence of POE amounted to 58 cases out of 54 666 cataract operations, or 0.1% of surgical cases. The predominant aetiology was gram-positive bacteria, which comprised 57% of the material. Acrylic intraocular lenses were found to decrease the risk of POE significantly in comparison to hydrogel and polymethylmethacrylate lenses. Conclusions: The incidence of POE after cataract surgery in Sweden is similar to that currently reported elsewhere in the developed world. We hope that continued registration of cases of POE in Sweden will shed light on the possible influences of various prophylactic measures and different intraocular lens materials on the development of postoperative infection.

The antibiotic resistance pattern of conjunctival bacteria: a key for designing a cataract surgery prophylaxis

“…27 Usually, these bacteria were isolated in very few PE cases, [5][6][7][8]22,23 compared with their high prevalence on the conjunctiva that we have found. Using the method of culturing for identifying the bacteria causing PE, the infectious origin of PE cases of relevant PE series [6][7][8]22,23 remains unknown in about 30% of the patients. In our experience, most conjunctival Corynebacteria and other diphtheroids require especial conditions for growth when cultured.…”

“…5 These patients were given 1 mg of intracameral cefuroxime at the end of each cataract surgery, as a prophylaxis. The cefuroxime efficacy in previous Swedish studies 6,7 had motivated its use in the ESCRS study. 2 However, in the final results of the ESCRS study, 8 the isolated bacterial spectrum of their PE cases was different from the last Swedish study spectrum, 5 as Table 1 illustrates.…”

Influence of intraocular lens material on the development of acute endophthalmitis after cataract surgery?

“…Consistent to our results, Montan et al 11 have demonstrated that patients implanted with heparinized PMMA IOLs are better protected against POE than are those with either PMMA (P ¼ 0.002) or silicone IOLs (P ¼ 0.04). However, in a more recent study, 12 the same authors demonstrated the risk of developing POE to be lower in patients with acrylic IOLs than in those with either silicone (P ¼ 0.014), PMMA (P ¼ 0.001), or hydrogel IOLs (P ¼ 0.001), whereas the risk difference between acrylic IOLs and heparinized PMMA IOLs was not significant (P ¼ 0.06). The lower risk of POE associated with heparinized PMMA IOLs was attributed by Montan et al 11 to the biocompatible, hydrophilic surface properties of the heparin coating.…”

“…[11][12][13][14][15][16][17][18] The present retrospective cohort study was conducted with a view to throwing further light on the association between IOL material and type and the risk of developing POE.…”

A Review of Antibiotic Prophylaxis for Post-operative Endophthalmitis

“…1 The rate of endophthalmitis achieved (0.09%) was comparable to that seen in developed countries. 32,33 Hosseini et al concluded that using povidone iodine 5% solution for 15 minutes or 10% for 5 minutes can prevent the growth of most post cataract surgery endophthalmitis bacterial isolates in vitro. 34 Ciulla et al in an evidence-based review of the literature on endophthalmitis prophylaxis, concluded that preoperative povidone-iodine prophylaxis was the single most effective means for reducing the risk for postoperative endophthalmitis.…”