gms | German Medical Science

Purpose: To evaluate the incidence of post-cataract surgery endophthalmitis in a tertiary eye centre in Asia and to describe the preventive measures employed.

Methods: Data on cataract surgery were prospectively collected over the last 18 years as part of a rigorous clinical audit program. This audit included preoperative and postoperative visual acuity data, videotaping of every cataract operation performed and data on all surgical complications, including endophthalmitis. There was a 100% audit of all cases of endophthalmitis. Preventive measures of endophthalmitis included careful screening for preoperative infection, topical povidone iodine antisepsis, preoperative topical antibiotics and meticulous draping of the eye. Topical antibiotics were instituted immediately after cataract surgery and continued postoperatively for about 2 weeks and then stopped abruptly (using an intensive high dose prophylactic regime without tapering to prevent bacterial resistance). No intracameral antibiotics or antibiotics in irrigating fluids were used. All surgeons in the centre were required to undergo a formal phacoemulsification training program before they were allowed to perform surgery unsupervised.

Results: Over the last 22 years, where 182,206 cataract operations were performed, the overall incidence of clinically-suspected endophthalmitis was 0.049% and that of culture-proven endophthalmitis was 0.030%. The annual incidence of endophthalmitis showed a downward trend since 2006. In 2008, the incidence of endophthalmitis was zero (0%).

Conclusion: The incidence of endophthalmitis following cataract surgery was among one of the lowest reported for large eye centres in the world. A very low rate of infection is possible with the implementation of the appropriate preventive measures, without the need for intracameral antibiotics or antibiotics in irrigating fluids.