Using the West Midlands CONCERT to characterise regional incidence of acute-onset post cataract surgery endophthalmitis

Abstract

Background Whilst research and innovation is embedded within the UK’s National Health Service (NHS) constitution, Doctors-in-training have little opportunity to contribute to designing, leading and recruiting into clinical trials or cohort studies. We formed the West MidlandsCollaborativeOphthalmologyNetwork forClinicalEffectiveness &Research byTrainees (The West Midlands CONCERT) and undertook a characterisation of post cataract surgery endophthalmitis as a proof-of-concept study to test the feasibility of the CONCERT model. Methods Doctors-in-training formed a collaborative working group to test the concept of delivering a pan-regional clinical effectiveness study across multiple hospital sites by performing retrospective analyses of post cataract endophthalmitis over a 6-year period. Results Overall, 157,653 cataract surgeries were performed by participating centres accredited to deliver the Royal College of Ophthalmologists training curriculum. Thirty-eight cases of post cataract endophthalmitis were identified, giving an incidence of 2.41 per 10,000 cases (0.0241%). A further 15 endophthalmitis cases presented who had surgery in non-training centres, giving a total of 53 cases. The most common organisms were S. epidermidis (14 (51.9%)) and P. aeruginosa (5 (18.5%)). Anterior-chamber and vitreous sampling yielded positive culture in 33.3% (6/18) and 50.9% (27/53), respectively. At 6 months follow-up, 19 (51.4%) patients achieved visual acuities of ≤0.5 LogMAR. Repeat intravitreal injections (11 (20.8%)) and vitrectomy (n = 22 (41.5%)) were not associated with better outcomes. Conclusions Using post cataract endophthalmitis as a pilot cohort, this study highlights the feasibility of using the CONCERT model for studies across multiple sites. A UK-CONCERT could provide a powerful infrastructure enabling characterisation of patient cohorts and a platform for high-quality interventional studies, improving patient care.

Deep Metagenomic Sequencing for Endophthalmitis Pathogen Detection Using a Nanopore Platform

“…It occurs secondary to pathogens entering the eye, either exogenously through a breach in the globe due to surgery or trauma, or endogenously via hematogenous spread from an infective focus elsewhere in the body largely in immunocompromised patients 1,2 . Incidence rates following intraocular procedures range from 2.5 to 50 per 10000 cases post-cataract surgery and 0.7 to 13 per 10000 cases following intravitreal injections worldwide 1,[3][4][5][6][7][8] . Despite aggressive medical and surgical interventions, endophthalmitis often results in permanent partial or total vision loss.…”

“…Conventional microbiology techniques in endophthalmitis rely on culture-based assays, but have low sensitivity, ranging between 40–70% 3 , 4 , 9 , 10 . Some causative pathogens, such as Cutibacterium acnes , are not easily cultured.…”