Efficacy of intracameral and subconjunctival cefuroxime in preventing endophthalmitis after cataract surgery

PURPOSE: To compare the efficacy of intracameral cefuroxime versus subconjunctival cefuroxime in reducing the rate of endophthalmitis after cataract surgery. SETTING: Single-specialty eye hospital, Sunderland, United Kingdom. METHODS: A retrospective analysis of all presumed infectious endophthalmitis cases from January 1,2000, to December 31,2006 was performed. The rate of presumed infectious endophthalmitis in patients receiving subconjunctival cefuroxime was compared with those receiving intracameral cefuroxime at the end of surgery. RESULTS: This study included 36743 phacoemulsification cataract procedures. The mean rate of presumed infectious endophthalmitis was 0.95 per 1000 cases. The incidence of endophthalmitis was higher in the subconjunctival cefuroxime group than in the intracameral cefuroxime group; the difference was statistically significant with an odds ratio of 3.01 (95% confidence interval, 1.37-6.63). CONCLUSION: Intracameral cefuroxime was a safe alternative to subconjunctival cefuroxime and led to a lower rate of endophthalmitis.     

Immediately sequential phacoemulsification performed under topical anaesthesia as day case procedures

AIMS: To evaluate the visual outcome, safety, and economic benefits of immediately sequential phacoemulsification performed under topical anaesthesia as a day case procedure. METHODS: Immediately sequential phacoemulsification under topical anaesthesia was performed as a day case procedure on 218 eyes of 109 patients over 21 months by a single senior surgeon using intracameral antibiotics. Case notes were retrospectively analysed. RESULTS: The final best corrected visual acuity (BCVA) was 6/9 or better in 86% of eyes with 47% achieving 6/6 or better. The incidence of intraoperative complications was 0.45%. Postoperative complications occurred in 13.8% of eyes and included refractive error >1.00D from refractive aim (6.9%). Bilateral complications occurred in 5.5% of the patients. There were no cases of endophthalmitis. The mean time from surgery to discharge was 24 days. CONCLUSION: Immediately sequential phacoemulsification under topical anaesthesia performed as a day case procedure is not associated with an increased number of complications when compared to unilateral phacoemulsification. Under strict surgical protocol with the use of intracameral antibiotics and performed by an experienced surgeon with a good track record this procedure is safe.     

前房内注射头孢呋辛预防超声乳化术后眼内炎的临床观察

目的：探讨前房内注射头孢呋辛对预防超声乳化术后眼内炎的临床效果。

方法：回顾性研究2015-01/2018-06在我院接受超声乳化白内障手术患者3 112例4 210眼的临床资料,以2015-01/2017-04诊治的1 810例2 250眼患者为对照组,以2017-05/2018-07诊治的1 302例1 960眼患者为试验组。两组患者均行超声乳化联合Ⅰ期人工晶状体植入术。试验组术毕前房内注射头孢呋辛1mg/0.1mL,对照组前房内未注射抗生素。术后随访1～8mo,观察两组患者的视力和感染性眼内炎发生情况。

结果：对照组术后6mo内最佳矫正视力>1.0者1 344眼,0.5～0.9者696眼,0.1～0.4者151眼,<0.1者59眼; 而试验组术后6mo内最佳矫正视力>1.0者1 136眼,0.5～0.9者624眼,0.1～0.4者146眼,<0.1者54眼。试验组术后6mo内未见眼内炎发生,对照组3例3眼(0.13%)术后发生眼内炎,两组比较差异无统计学意义(P=0.15)。对照组3例3眼眼内炎患者经全身联合眼局部治疗后治愈。试验组前房注药后均未见角膜内皮失代偿、视网膜毒性等药物相关毒性和过敏反应。

结论：前房内注射头孢呋辛能有效预防超声乳化术后眼内炎的发生,安全有效。     

Computer aided diabetic retinopathy detection based on ophthalmic photography: a systematic review and Meta-analysis

AIM: To ensure the diagnostic value of computer aided techniques in diabetic retinopathy (DR) detection based on ophthalmic photography (OP). METHODS: PubMed, EMBASE, Ei village, IEEE Xplore and Cochrane Library database were searched systematically for literatures about computer aided detection (CAD) in DR detection. The methodological quality of included studies was appraised by the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). Meta-DiSc was utilized and a random effects model was plotted to summarize data from those included studies. Summary receiver operating characteristic curves were selected to estimate the overall test performance. Subgroup analysis was used to identify the efficiency of CAD in detecting DR, exudates (EXs), microaneurysms (MAs) as well as hemorrhages (HMs), and neovascularizations (NVs). Publication bias was analyzed using STATA. RESULTS: Fourteen articles were finally included in this Meta-analysis after literature review. Pooled sensitivity and specificity were 90% (95%CI, 85%-94%) and 90% (95%CI, 80%-96%) respectively for CAD in DR detection. With regard to CAD in EXs detecting, pooled sensitivity, specificity were 89% (95%CI, 88%-90%) and 99% (95%CI, 99%-99%) respectively. In aspect of MAs and HMs detection, pooled sensitivity and specificity of CAD were 42% (95%CI, 41%-44%) and 93% (95%CI, 93%-93%) respectively. Besides, pooled sensitivity and specificity were 94% (95%CI, 89%-97%) and 87% (95%CI, 83%-90%) respectively for CAD in NVs detection. No potential publication bias was observed. CONCLUSION: CAD demonstrates overall high diagnostic accuracy for detecting DR and pathological lesions based on OP. Further prospective clinical trials are needed to prove such effect.     

Commonly used intracameral antibiotics for endophthalmitis prophylaxis: A literature review

Endophthalmitis is a serious complication of cataract surgery that occurs in thousands of patients each year. To decrease the incidence of postoperative endophthalmitis, many surgeons inject intracameral antibiotics (cefuroxime, moxifloxacin, and vancomycin) routinely at the end of surgery. A large number of recently published retrospective studies and large database analyses have reported decreased endophthalmitis rates with routine antibiotic use, and the only prospective, multicenter, randomized trial performed by the European Society of Cataract and Refractive Surgery demonstrated that intracameral cefuroxime decreases the incidence of postoperative endophthalmitis. Routine cefuroxime use has become common in many European countries, whereas moxifloxacin is the most commonly used drug in India, and vancomycin use predominates in Australia. The decision regarding whether or not to use intracameral prophylaxis and the drug that is selected varies considerably throughout the world because of antibiotic availability and cost, and the spectrum of causative organisms. Adverse events due to intracameral antibiotics are infrequent, but complications such as hemorrhagic occlusive retinal vasculitis have been reported. Because additional prospective, comparative trials have not been performed, a consensus regarding best practices to prevent postoperative endophthalmitis has not been reached. Additionally, many surgeons do not routinely use intracameral antibiotics because they believe them unnecessary with modern aseptic techniques, small incision surgery, and shorter operating times. We discuss the most commonly used intracameral antibiotics, present the risks and potential benefits of this approach, and highlight challenges with drug compounding and safety.     

Cataract surgery practice and endophthalmitis prevention by Australian and New Zealand ophthalmologists

PURPOSE: Our aim was to examine current cataract surgery practice and the methods of chemoprophylaxis used in Australia and New Zealand, and to determine if these factors were related to self-reported incidence rates of postoperative endophthalmitis. METHODS: All Fellows and trainees of the Royal Australian and New Zealand College of Ophthalmologists were surveyed about their cataract surgery practices and methods of chemoprophylaxis for the prevention of postoperative endophthalmitis. Associations between self-reported incidence rates of endophthalmitis and clinical practice were examined using multivariate Poisson regression modelling. RESULTS: There were 731 respondents (81.6% of 896 surveyed) to the survey. Respondents reported a total of 162,120 cataract operations and 92 cases of endophthalmitis in 2003, a cumulative incidence of 0.057%. The self-reported incidence of endophthalmitis varied from 0.034% in Victoria to 0.56% in the Northern Territory. Topical antibiotics were used preoperatively by 46.7% compared with 97.4% postoperatively; while only 44.1% used subconjunctival antibiotics. The routine use of subconjunctival antibiotic halved the self-reported incidence of postoperative endophthalmitis (incidence rate ratio 0.53, 95% confidence interval 0.30-0.92). CONCLUSIONS: Subconjunctival antibiotics may be beneficial in the prevention of endophthalmitis after cataract surgery.     

Risk factors for endophthalmitis following cataract surgery-our experience at a tertiary eye care centre in India

AIM: To determine the risk factors for acute endophthalmitis after cataract extraction in a tertiary care centre in India. METHODS: We performed a nested case control study within a retrospective cohort. The surgical records of all patients with clinically diagnosed endophthalmitis within one month after cataract surgery, performed between January 2006 and December 2009, were reviewed. These were compared with randomly selected age and gender-matched controls, from patients having routine cataract surgery within ±1wk of the endophthalmitis case. Univariable and multivariable analysis were performed to identify risk factors for endophthalmitis. RESULTS: Of the total 33 856 cataract surgeries performed during this period, there were 57 cases of postoperative acute endophthalmitis that met our study criteria. Thus, the overall incidence of endophthalmitis in our cohort was 1.6 per 1000 cataract extractions performed. Mean age of cases was 55.9y (SD: 10.9y) and for controls was 55.6y (SD: 9.8y). Thirty-five cases (61.4%) and 133 controls (59.6%) were males. Median time of onset of endophthalmitis was 4d (IQR 2-9d; range: 1-30d). Thirty-nine cases (68.4%) presented within 7d and 27 cases (47.4%) were culture positive. Two hundred and twenty-three age and gender matched controls were selected. In multivariate analysis, endophthalmitis was associated with posterior capsular rupture (PCR) during surgery (OR 6.98, 95%CI: 2.22-21.98), phacoemulsification via scleral incision with a foldable intraocular lens (IOL) implantation (OR 3.02, 95%CI: 1.13-8.04) and ocular co-morbidity (OR 2.32, 95%CI: 1.11-4.87). CONCLUSION: PCR, presence of ocular co-morbidity, and phacoemulsification via scleral incision with foldable-IOL were found to be independent risk factors for acute endophthalmitis.     

The epidemiology of acute endophthalmitis after cataract surgery in an Asian population

OBJECTIVE: To describe the incidence, risk factors, and clinical outcome of acute endophthalmitis after cataract extraction in a multiethnic Asian population. DESIGN: Prospective case series. PARTICIPANTS: All patients with cataract extractions performed at the Singapore National Eye Center from 1996 to 2001. METHODS: Data on patients with acute endophthalmitis cases presenting within 6 weeks after cataract surgery were prospectively collected in a standardized format. MAIN OUTCOME MEASURES: Acute endophthalmitis after cataract surgery. RESULTS: During the study period, 44 803 cataract operations (25 476 phacoemulsification and 19 327 extracapsular cataract extractions) were performed. There were 34 cases of acute endophthalmitis (average annual incidence of 0.076%), 21 of which were culture positive (average annual incidence of 0.040%). In multivariate analysis, risk of endophthalmitis was associated with phacoemulsification technique (relative risk [RR], 1.9; 95% confidence interval [CI], 0.9, 3.9; P = 0.10 for all endophthalmitis cases; RR, 3.1; 95% CI, 1.1, 9.4; P = 0.04 for culture-positive endophthalmitis cases) and the occurrence of intraoperative posterior capsule rupture (RR, 8.0; 95% CI, 3.1, 20.7; P<0.001 for all endophthalmitis cases; RR, 11.0; 95% CI, 3.7, 23.9; P<0.001 for culture-positive endophthalmitis cases). After a median follow-up of 234 days, half of the eyes achieved a final best-corrected visual acuity of 20/40. Predictors of this visual acuity included baseline acuity of counting fingers or better, culture-negative endophthalmitis, or infection caused by coagulase-negative Staphylococcus. CONCLUSION: The incidence of acute endophthalmitis after cataract extraction in Singapore is consistent with rates reported elsewhere. The phacoemulsification technique is associated with a higher risk of acute culture-positive endophthalmitis compared with extracapsular cataract extraction. Intraoperative posterior capsule rupture is associated with an 8- to 11-fold higher risk of acute endophthalmitis, suggesting that these eyes should be closely monitored for signs of infection in the immediate postoperative period.     

Prophylaxis of acute posttraumatic bacterial endophthalmitis with or without combined intraocular antibiotics: a prospective, double-masked randomized pilot study

PURPOSE: The effectiveness of an intraocular injection of combined gentamicin and clindamycin in the prevention of acute posttraumatic bacterial endophthalmitis following penetrating ocular injuries was evaluated in a prospective, double-masked, randomized pilot study. METHODS: Sixty eyes of 60 patients with penetrating ocular injuries were treated at a tertiary care hospital. Following primary repair, the eyes were randomized in two groups. Group 1, the antibiotic injection group (cases), was given an intracameral or intravitreal injection of 0.1 mL antibiotic (40 microg gentamicin and 45 microg clindamycin). Group 2 (balanced saline solution [BSS] injection group [controls]) received intracameral or intravitreal injection of 0.1 mL BSS. All patients received standard prophylactic antibiotic therapy (systemic, subconjunctival, and topical). RESULT: Although the overall incidence of acute posttraumatic bacterial endophthalmitis was 6.6% (4 eyes), the results of three cultures were negative. All endophthalmitis cases occurred in the BSS injection group; however, there was no statistically significant difference between case and control groups (p = 0.11). The incidence rate for those with retained intraocular foreign bodies was 13.3% and for those without foreign bodies was 4.4%. No retinal toxicity was detected. CONCLUSION: Intraocular injection of gentamicin and clindamycin in addition to the other methods of prophylaxis may be an effective modality in the prevention of posttraumatic endophthalmitis. Early results suggest that these antibiotics may have a role as adjunct therapy to primary repair of injured globes without significant side effects at the dosage used.     

Bacterial contamination of the anterior chamber during phacoemulsification cataract surgery

PURPOSE: To determine the incidence of bacterial contamination of the anterior chamber after phacoemulsification cataract surgery with intraocular lens (IOL) implantation. SETTING: Department of Ophthalmology, Royal Prince Alfred Hospital, Sydney, Australia. METHODS: Ninety-eight consecutive eyes of 96 patients having phacoemulsification cataract surgery with IOL implantation were included in this prospective study. Two intraoperative anterior chamber aspirates were obtained from each patient, 1 taken at the start and the other at the conclusion of surgery. In addition, preoperative and postoperative conjunctival swabs were acquired. The 4 specimens were cultured using direct culturing techniques under aerobic and anaerobic conditions for 14 days. No preoperative antibiotics were used. RESULTS: The incidence of intraoperative anterior chamber contamination was 0% (95% confidence interval, 0%-3.7%) as all intraoperative anterior chamber samples proved culture negative. Sixty-five percent of the preoperative conjunctival swabs were positive for growth, with corynebacteria, coagulase-negative staphylococci, and Propionibacterium acnes being the most frequently cultured organisms. Sixteen percent of the postoperative conjunctival swabs were positive for growth, with corynebacteria and coagulase-negative staphylococci being the most common bacteria. One patient developed culture-positive postoperative endophthalmitis; using pulsed-field gel electrophoresis for further typing, the implicated Staphylococcus epidermidis was indistinguishable from that isolated from the patient's preoperative conjunctival swab. CONCLUSIONS: The bacterial contamination rate of the anterior chamber after phacoemulsification and IOL implantation was extremely low. Additional findings support the conjunctiva as being a primary source of bacteria causing postoperative endophthalmitis as well as the ability of povidone-iodine to reduce the conjunctival bacterial load.     

前房注射头孢呋辛预防白内障术后眼内炎的临床效果

目的　探讨白内障术末前房注射头孢呋辛对眼内炎发生率的影响,评价该预防措施的临床效果。方法　回顾性研究２００９－２０１５年在我科接受白内障手术的１０５１５眼患者资料,统计各年份白内障患者中接受前房注射头孢呋辛的比例、眼内炎的发生率及逐年累积发生率。对术后眼内炎患者的年龄、性别、视力、病原菌及接受注射的情况进行分析。结果　过去７ａ接受白内障手术者５９９５例（１０５１５眼）,其中９３８２眼（８９．２％）接受了前房注射头孢呋辛１ｍｇ／０．１ｍＬ。随着头孢呋辛前房注射比例的增加,感染性眼内炎发生率由０．１８２％（２００９年）降至０．０７２％（２０１１年）,７ａ总体累积发生率为０．０３８％（９５％ ＣＩ,０．００１－０．０７５）。２００９－２０１１年白内障术后发生眼内炎４例,平均潜伏期３．７５ｄ。２０１２－２０１５年无眼内炎病例发生。所有接受注射的患者未发生药物毒性及过敏反应。结论　白内障术末前房注射１ｍｇ／０．１ｍＬ头孢呋辛安全有效,术后眼内炎的发生率明显降低,有望作为白内障围手术期预防感染的常规措施。     

Survey of practice preference pattern in antibiotic prophylaxis against endophthalmitis after cataract surgery in Singapore

To determine practice preference of prophylaxis against post-cataract surgery endophthalmitis in Singapore. Prospective nationwide survey of all registered ophthalmologists through telephone, e-mail or postal questionnaires. A response rate of 76.6% was obtained from 121 out of 158 eligible ophthalmologists. Awareness of the recommendations made by the European Society of Cataract and refractive surgeons (ESCRS) endophthalmitis study was noticed in 98 (81.0%) respondents. Out of the 121 respondents, 85 (70.2%) do not use intracameral antibiotic prophylaxis. Of the 36 respondents using intracameral antibiotics, 34 (94.4%) used cefazolin. The reasons cited for not adopting intracameral antibiotic prophylaxis included financial costs, the relatively low risk of endophthalmitis after cataract surgery, the burden of dilution and the fear of toxic anterior segment syndrome. More than half (65, 53.7%) of respondents would use intracameral antibiotic prophylaxis if it were available commercially. The most commonly practiced prophylaxis (94, 77.7%) was preoperative topical antibiotics. The majority of ophthalmologists in Singapore have not adopted the use of intracameral antibiotics, with most preferring the use of pre- and postoperative prophylactic topical antibiotics, despite knowledge of the ESCRS endophthalmitis study.     

Endophthalmitis Progressing to Panophthalmitis: Clinical Features,Demographic Profile,and Factors Predicting Outcome

Purpose: To describe clinical features, demographic profile and factors predicting outcome of endophthalmitis under care progressing to panophthalmitis at a tertiary eye institute. Setting: Retrospective consecutive case series. Methods: All cases diagnosed as endophthalmitis of any etiology and undergoing treatment which progressed to panophthalmitis from January 2005 to December 2015 were included. Case records of all patients coded as endophthalmitis and then panophthalmitis were included. Data were collected regarding the clinical features, demographic profile, and treatment outcomes of those cases. Results: This study included 33 eyes of 33 patients. The mean age at presentation was 42.33 ± 21.66 years (median 40, range 5–75). The commonest etiology of endophthalmitis progressing to panophthalmitis was noted following open globe injury endophthalmitis, seen in 13/33 (39.4%) of eyes followed by endophthalmitis associated with microbial keratitis seen in 8/33 (27.3%) eyes. The time interval in days between the diagnosis of endophthalmitis and progression to panophthalmitis was 4.5 ± 3.88 days (median 3 days, range 1–14 days). Fifteen eyes denied perception of light (PL) at the time of diagnosing panophthalmitis. Culture was positive in 16 cases (48.4%), Streptococcus pneumoniae was the commonest species (4 cases) followed by Pseudomonas aeruginosa (3 cases) and Staphylococcus epidermidis (2 cases). Nine cases (27.27%) were additionally given systemic steroids along with the systemic antibiotics. The odds ratio of a favorable outcome was significantly higher when systemic steroids with antibiotics were administered (OR = 80.5, 95% C.I. 6.311026, p = 0.007), when the patient was of a younger age group (< 40 years) (OR 1.53, 95% C.I. 0.37.87, p = 0.6), when the presenting vision at diagnosis was at least light perception (OR 9.8, 95% C.I. 1.03692.7, p = 0.04), when the smear showed Gram-positive cocci (OR 6.66, 95% C.I. 1.0940.43, p = 0.03), if there was culture positivity (OR 10.5, 95% C.I. 1.1198.9, p = 0.03) and when intravenous antibiotics were administered (OR 21.43, 95% C.I. 1.11411.7, p = 0.04). Conclusions: Risk of progression of endophthalmitis to panophthalmitis is there even under care. Close observation and keen clinical examination for cases that do not respond well is essential. Intravenous antibiotics and systemic steroids should be considered in all cases of endophthalmitis that progress to panophthalmitis.     

Safety of intracameral cefuroxime in pars plana vitrectomy

Background/objectivesPostoperative endophthalmitis is a rare, but serious complication of pars plana vitrectomy (PPV). Subconjunctival cefuroxime injection has been the traditional choice for post vitrectomy endophthalmitis prophylaxis. Its effectiveness and safety in this context are however poorly understood and cases of retinal toxicity have been reported. The traditional standard subconjunctival antibiotic prophylaxis has been superceded in cataract surgery by intracameral antibiotic prophylaxis.Subjects/methodsThe primary aim of this three centre non-randomised retrospective database cohort study of 7,532 PPV procedures was to identify the rate of endophthalmitis in cohorts of patients treated with intracameral or subconjunctival cefuroxime. A secondary aim was to estimate the achieved intraocular antibiotic concentrations of cefuroxime in eyes with intracameral versus subconjunctival administration using mathematical modelling.ResultsThe overall incidence of postoperative endophthalmitis was 0.07% (5/7532). There were no cases of endophthalmitis in eyes receiving intracameral cefuroxime alone or in combination with subconjunctival cefuroxime (0/5586). Patients receiving subconjunctival cefuroxime alone had a higher incidence of endophthalmitis (0.22%, 4/1835), and there was one case of endophthalmitis in eyes not receiving any perioperative antibiotics (0.9%, 1/111). No cases of cefuroxime toxicity were identified. With subconjunctival cefuroxime, in the presence of a sclerotomy leak, we estimated the vitreous drug concentration to be higher than that for intracameral cefuroxime and potentially toxic.ConclusionsIntracameral cefuroxime appears to be a safe and efficient choice for prophylaxis against endophthalmitis after PPV. Small eyes with intraocular tamponade seem to be at particular risk of drug toxicity if cefuroxime is administered via the subconjunctival route.Subject terms: Retinal diseases, Outcomes research     

Endophthalmitis in cataract surgery: results of a German survey.

OBJECTIVE: To document perioperative prophylactic treatment and to evaluate the risk factors for endophthalmitis after cataract surgery. DESIGN: Cross-sectional study via anonymous survey. PARTICIPANTS: Four hundred sixty-nine centers in Germany were queried. RESULTS: A total of 311 (67%) questionnaires were received, with each center reporting an average of 900 cataract surgeries per year (total, 340,633 surgeries in 1996). Respondents reported a total of 267 cases of endophthalmitis, which resulted in a mean responder-specific endophthalmitis rate of 0.148% versus a median rate of 0%. Statistical analysis via Poisson regression suggested that sclerocorneal incisions were associated with a reduced incidence of endophthalmitis (odds ratio, 0.35; 95% confidence interval, 0.24-0.51). Antibiotics used intraocularly (odds ratio, 0.65; 95% confidence interval, 0.43-0.98) and the preoperative application of diluted povidone-iodine on the conjunctiva (odds ratio, 0.59; 95% confidence interval, 0.36-0.99) were associated with a reduced risk of postoperative infection. Immune deficiencies (66%), diabetes mellitus (62%), occlusion of the lacrimal system (40%), and skin diseases (33%) were regarded as risk factors for endophthalmitis by the respondents. When cataract surgery is performed solely under inpatient conditions, the use of systemic antibiotics as well as the periocular injection of antibiotics at the end of the operation were associated (although not significantly) with a trend toward reducing the incidence of postoperative infection. Conversely, flushing the lacrimal drainage system, using eye shields, and cutting the eyelashes had no demonstrable effect in preventing endophthalmitis. The use of preoperative topical antibiotics (odds ratio, 2.38; 95% confidence interval, 1.21-4.68) and the performance of more than 20% of the surgeries in an outpatient center (odds ratio, 2.0; 95% confidence interval, 1.24-3.21) were associated with a detrimental effect on the development of endophthalmitis. CONCLUSIONS: Although the appropriate antibiotic agent and dosage are not yet established, the administration of intracameral antibiotics and the application of povidone-iodine on the conjunctiva significantly reduced the relative risk of postoperative endophthalmitis in this survey. Because the study was not individual based but rather on aggregate questionnaire, the results have to be interpreted with care.     

Endophthalmitis following cataract surgery in Sweden: national prospective survey 1999-2001

PURPOSE: To investigate the epidemiology of postoperative endophthalmitis (POE) following cataract surgery in Sweden during a 3-year period, using the framework of the Swedish National Cataract Register. METHODS: Clinically presumed cases of POE were reported in a prospective survey involving all Swedish ophthalmic surgical units except one. Data on results of the intraocular culture and visual outcome after infection, as well as patient age and gender and various elements of the surgical procedure, were collected. RESULTS: The nationwide incidence of POE was 0.0595%, representing 112 cases in 188 151 cataract operations. Gram-positive bacteria were the predominant aetiology, with an 84.6% share of culture-positive cases. A significantly decreased risk for POE was found for patients who had received prophylactic intracameral antibiotics (mainly cefuroxime) in comparison with those who had been treated with topical antibiotics only. CONCLUSIONS: The prevalence of POE after cataract surgery in Sweden is at the lower end of the spectrum of incidence currently reported in the developed world. The administration of intracameral antibiotics may have contributed to these results.     

The Malaysian cataract surgery registry: incidence and risk factors of postoperative infectious endophthalmitis over a 7-year period

AIM: To report the incidence, risk factors and visual outcomes for postoperative endophthalmitis (POE) based on 7-year data from the Malaysian Ministry of Health Cataract Surgery Registry (MOH CSR). METHODS: Data was collected from the web-based MOH CSR. All consecutive cataract surgery patients from 1st June 2008 to 31st December 2014 were identified. Exclusion criteria were traumatic cataract or previous ocular surgery. Demographic data, ocular co-morbidities, intraoperative details and postoperative visual acuity (VA) at final ophthalmological follow-up were noted. All eyes were taken for analysis. Subjects with POE were compared against subjects with no POE for risk factor assessment using multiple logistic regressions. RESULTS: A total of 163 503 subjects were screened. The incidence of POE was 0.08% (131/163 503). Demographic POE risk factors included male gender (OR: 2.121, 95%CI: 1.464-3.015) and renal disease (OR: 2.867, 95%CI: 1.503-5.467). POE risk increased with secondary causes of cataract (OR: 3.562, 95%CI: 1.740-7.288), uveitis (OR: 11.663, 95%CI: 4.292-31.693) and diabetic retinopathy (OR: 1.720, 95%CI: 1.078-2.744). Intraoperative factors reducing POE were shorter surgical time (OR: 2.114, 95%CI: 1.473-3.032), topical or intracameral anaesthesia (OR: 1.823, 95%CI: 1.278-2.602), posterior chamber intraocular lens (PCIOL; OR: 4.992, 95%CI: 2.689-9.266) and foldable IOL (OR: 2.276, 95%CI: 1.498-3.457). POE risk increased with posterior capsule rupture (OR: 3.773, 95%CI: 1.915-7.432) and vitreous loss (OR: 3.907, 95%CI: 1.720-8.873). Postoperative VA of 6/12 or better was achieved in 15.27% (20/131) subjects with POE. CONCLUSION: This study concurs with other studies regarding POE risk factors. Further strengthening of MOH CSR data collection process will enable deeper analysis and optimization of POE treatment.