Patterns of peri-operative prophylaxis for cataract surgery: A survey of Australian ophthalmologists

Background: Although peri-operative prophylaxis to prevent endophthalmitis is commonly practised by ophthalmologists, no one method has clearly been demonstrated to be more effective than another. We surveyed 570 Fellows of the Royal Australian College of Ophthalmologists to determine what their methods of prophylaxis were and whether these differed for patients who developed endophthalmitis. Methods: The questionnaire asked about the types of antibiotics and other methods of prophylaxis used before, during and after cataract surgery. Of those who reported cases of endophthalmitis, we asked specifically about the methods of prophylaxis used for those patients. Results: The response was 89% and the incidence of endophthalmitis was calculated as 0.11%. There was little difference in the methods of prophylaxis used by those who reported endophthalmitis compared with others, but pre-operative antibiotics were used more commonly by those who reported the disease (P= 0.06). Surgeons who had practised for 20 years or more reported a lower rate of endophthalmitis than others, as did those who performed more than 300 cataract operations per year. However, the pattern of prophylaxis used by these two sub-groups was quite divergent. Differences in the methods of prophylaxis had no bearing on the development of endophthalmitis, with the exception that subconjunctival antibiotics were used less often in those patients who developed the disease (P= 0.03). Conclusions: The results of the present study provide no clear answer regarding appropriate peri-operative prophylaxis. The wide range of prophylactic regimens used suggests that no one method is superior to another. Formal case-controlled studies are required to identify which method would be most efficacious.     

白内障术后眼内感染及其防治

白内障术后眼内炎是一种严重危害视力的术后并发症，眼内炎的预防包括临床评价各种危险因素、正确的手术步骤和术前术后抗生素预防，只有迅速诊断和有效治疗才能成功地挽救患者的视力。     

Intracameral antibiotics for prophylaxis of postoperative endophthalmitis in Australia: a review

Postoperative endophthalmitis is a severe complication which may result in loss of vision. Intracameral antibiotics have been shown to reduce the risk of this complication and are extensively used worldwide, with vancomycin, cefuroxime and moxifloxacin most commonly used. Choices in Australia are currently limited to vancomycin and cefazolin, since cefuroxime and moxifloxacin are not available. Vancomycin has been safely and effectively used in our department for more than two decades. Recent publications have risen concerns regarding the association of haemorrhagic occlusive retinal vasculitis a potentially blinding complication with intracameral vancomycin. This concern has driven us to review the safety and efficacy of currently available antibiotics in the context of Australian practice.     

白内障术后眼内炎药物预防研究进展

白内障术后眼内炎是一种少见但破坏性极大的并发症。预防眼内炎的方式多种多样,其中术前应用聚维酮碘（povidone iodine,PVI）,术毕前房注射抗生素如万古霉素、头孢呋辛和氟喹诺酮类药物,以及围手术期局部抗生素应用是预防眼内炎的主要方式。本文就白内障术后眼内炎的流行病学、危险因素、致病因素及药物预防的研究进展作一综述。     

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.     

Incidence of endophthalmitis after phacoemulsification cataract surgery: a Meta-analysis

AIM:To evaluate the overall endophthalmitis incidence and the effectiveness of potential prophylaxis measures following phacoemulsification cataract surgery(PCS).METHODS:The Pub Med and Web of Science databases were searched from inception to April 30^th,2021.We included studies that reported on the incidence of endophthalmitis following PCS.The quality of the included studies was critically evaluated with the Newcastle-Ottawa quality assessment scale.The random effect or the fixed-effects model was used to evaluated the pooled incidence based on the heterogeneity.The publication bias was assessed by Egger’s linear regression and Begg’s rank correlation tests.RESULTS:A total of 39 studies containing 5 878 114 eyes were included and critically appraised in the Meta-analysis.For overall incidence of endophthalmitis after PCS,the Meta-analysis yielded a pooled estimate of 0.092%(95%CI:0.083%-0.101%).The incidence appeared to decrease with time(before 2000:0.097%,95%CI:0.060%-0.135%;2000 to 2010:0.089%,95%CI:0.076%-0.101%;after 2010:0.063%,95%CI:0.050%-0.077%).Compared with typical povidone-iodine solution(0.178%,95%CI:0.071%-0.285%) and antibiotics subconjunctival injections(0.047%,95%CI:0.001%-0.095%),the use of intracameral antibiotics significantly reduced the incidence of endophthalmitis after PCS(0.045%,95%CI:0.034%-0.055%,RR:7.942,95%CI:4.510-13.985).CONCLUSION:Due to the advancement of phacoemulsification technology and the widespread use of intracameral antibiotics,the incidence of endophthalmitis following PCS shows a decreasing trend over time.The use of intracameral antibiotics administration will significantly reduce the risk of endophthalmitis.     

Infectious endophthalmitis: clinical features, management and visual outcomes

Aim: To identify the clinical features and outcomes of infectious endophthalmitis in New Zealand. Methods: A retrospective review was performed on all patients presenting at Auckland Public Hospital with presumed infectious endophthalmitis between 1996 and 2004. Results: One hundred and six patients were diagnosed with infectious endophthalmitis over the 9‐year study period. More than half the infections occurred in the perioperative setting (58.5%), with the next most common group being patients with a history of ocular trauma (18.9%). Endogenous endophthalmitis accounted for 16.0% of the cases while a small percentage arose from other causes. The mean interval between the onset of symptoms and presentation was 4.2 ± 7.9 days. There was no significant difference in outcomes between clinical settings (P = 0.616) or between gram‐positive, gram‐negative and fungal infections (P = 0.090). Evisceration/enucleation was more likely in Pacific peoples and those with poor presenting visual acuity. Conclusions: The most common clinical scenario for patients presenting with presumed infectious endophthalmitis in this series was in the perioperative setting. We did not find that the prognosis was influenced by the microbiological isolate or clinical setting. However, those patients presenting with poor acuities typically had the worst outcomes. Pacific ethnicity was also associated with increased rate of complications.     

白内障术后眼内感染的分析及其防治

白内障术后感染性眼内炎是严重危害患者术后视力恢复的并发症之一。本文就其发病率?危险因素?治疗及预防等做一综述,为临床医生提供参考依据。     

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。     

白内障术后眼内炎临床分析

目的探讨白内障术后发生眼内炎的临床危险因素和防治。方法收集连续白内障术后12600例进行回顾性分析。结果白内障术后眼内炎是由多因素导致的,包括患者自身条件,医生和医院因素,抗生素的应用,手术过程和人工晶状体材料等。结论采取相关防治措施对于白内障术后眼内炎的预防至关重要。     

Clinical Analysis of Cataract Surgery Complicated by Endophthalmitis

Purpose:.To assess the efficacy of vitrectomy combined with intravitreal injection in the treatment of endophthalmitis after phacoemulsification and IOL implantation. Methods:.Five patients.(5 eyes),.who had undergone conventional phacoemulsification combined with IOL implantation at another treatment facility,.presented with endophthalmitis. The subjects ranged in age from 41 to 79 years (65.8±0.5 years on average),.and three were male..All five cases received bacterial culture susceptibility testing..On the basis of the treatment of primary disease, 3 cases had anterior chamber irrigation,.and posterior vitrectomy followed by intravitreal injection of 1 mg vancomycin plus 2.25 mg ceftazidime. Results:.Four out of the five cases of endophthalmitis had a positive bacterial culture testing results.(two cases of staphylococcus epidermidis,.one case of enterococcus faecalis and one case of head-like staphylococcus),.and the remaining case had no bacterial growth..Four cases showed restored visual acuity,.clear vitreous cavity,.and no retinal detachment or other complications. Conclusion: Management of patients presenting with endophthalmitis subsequent to cataract surgery should include: prompt bacterial culture and drug sensitivity tests, and where appropriate, vitrectomy combined with intravitreal injection of vancomycin.     

白内障术后感染性眼内炎的临床观察

目的探讨白内障术后感染性眼内炎的感染途径和治疗措施。方法回顾性分析2005至2006年间入院的8例8眼白内障术后感染性眼内炎病例。结合既往病史和临床检查探讨其感染途径。6例行玻璃体切除联合人工晶体摘除,并结合玻璃体腔内药物注射。结果导致感染的途径主要为白内障手术切口。3例细菌培养结果为表皮葡萄球菌。7例随访期末视力有提高,最高达0.3。结论白内障围手术期规范细致的操作是预防术后感染性眼内炎的重要措施。玻璃体切除联合人工晶体摘除是值得采用的有效治疗步骤。     

白内障术后感染性眼内炎治疗11例

目的探讨白内障术后感染性眼内炎相关因素及治疗方法。方法对我院1999年11月至2005年10月11例11眼白内障术后感染性眼内炎进行回顾性分析。结果7眼细菌培养阳性，培养细菌包括：表皮葡萄球菌2眼，粪肠球菌1眼，催产克雷白菌1眼，腐生葡萄球菌1眼，异型枸橼酸杆菌1眼，醋酸不动杆菌1眼。行后部玻璃体切割术者5眼，其中眼球摘除1眼；单纯前房冲洗加注药2眼；前房冲洗注药联合玻璃体腔注药4眼。结论前房和玻璃体注药，后部玻璃体切割术是治疗的有效方法。     

Trends in cataract surgery and postoperative endophthalmitis in Western Australia (1980-1998): the Endophthalmitis Population Study of Western Australia

Objectives: Postoperative endophthalmitis results from an intraocular infection and usually occurs following cataract surgery. It has significant morbidity and causes severe visual impairment or blindness of the eye. The aim of this study was to assess the trends in the incidence rates of cataract surgery and postoperative endophthalmitis in Western Australia for the period 1980?1998. Methods: The Western Australian Record Linkage Project was used to link the morbidity records for all patients treated for cataract surgery in Western Australia in 1980?1998. Patient records were selected using the international classification for diagnosis and procedure codes pertaining to cataract surgery and postoperative endophthalmitis. All cases of postoperative endophthalmitis were validated by case‐note review. The separate databases of the Royal Perth Hospital microbiology and anaesthetic departments as well as the vitreo‐retinal surgeon logbooks were used to cross‐validate the hospital morbidity database. Trends in the incidence rates of cataract surgery and postoperative endophthalmitis were assessed by Poisson regression. Results: There were 94 653 cataract procedures performed for 63 007 patients in Western Australia during the 19‐year period. The majority (88%) of cataract procedures performed were in patients aged 60 years or older. Postoperative endophthalmitis developed in 188 patients, with serious visual impairment occurring in 70.6% of patients for whom visual acuity data was available at presentation. The incidence rate of cataract surgery increased more than three‐fold from 1981 (102 per 100 000 person years) to 1998 (345 per 100 000 person years), mainly due to the increase in extracapsular cataract extraction during the 1980s and phacoemulsification extraction from 1990 onwards. In contrast, the average annual incidence rate of postoperative endophthalmitis remained relatively unchanged at around 2 per 1000 cataract procedures over the same period. Conclusion: Cataract surgery is becoming more prevalent in the elderly as the life expectancy of the population increases. There has been a dramatic shift in surgical practice during the last 30 years with small‐incision phacoemulsification being the predominant method of intervention used since 1990. Despite changes in surgical practice the incidence rate of postoperative endophthalmitis has remained the same.