Acute-onset endophthalmitis after cataract surgery (2000-2004): incidence, clinical settings, and visual acuity outcomes after treatment.

PURPOSE: To report the incidence, clinical settings, and visual acuity outcomes of acute-onset endophthalmitis after cataract surgery. DESIGN: Retrospective, observational case series. METHODS: Annual cataract surgery statistics were determined by review of electronic surgical records. The clinical and microbiologic records were reviewed of all patients with clinically diagnosed endophthalmitis within 6 weeks after cataract surgery at a single university-affiliated hospital between January 2000 and November 2004. main outcome measures: Operative technique, intraoperative complications, and visual acuity. RESULTS: The incidence of acute-onset endophthalmitis after cataract surgery was 0.04% (7/15,920) for cataract surgeries of all methods, 0.05% (6/11,462) for cataract surgery by clear cornea phacoemulsification, and 0.02% (1/4,458) for cataract surgery by methods other than clear cornea phacoemulsification (P = .681, Fisher's exact test). Six of seven (86%) cases occurred in the right eye, and all cases were performed by right-handed surgeons through temporal incisions. Five of seven (71%) patients had relative immune compromise. Four of seven (57%) patients had an intraoperative complication: vitreous loss in three patients and iris prolapse in one patient. Two patients had topical placement of lidocaine 2% gel before povidone-iodine preparation. The visual acuity at final follow up was 20/25 or better in four patients and count fingers or worse in three patients. CONCLUSIONS: The incidence of acute-onset endophthalmitis after temporal clear cornea incision phacoemulsification is low (0.05%). Potential risk factors for endophthalmitis may include intraoperative complications, relative immune compromise, application of lidocaine 2% gel before povidone-iodine preparation, and inferior incision location.

Endophthalmitis after pars plana vitrectomy: Incidence, causative organisms, and visual acuity outcomes.

PURPOSE: To investigate the incidence, causative organisms, and visual acuity outcomes associated with endophthalmitis after pars plana vitrectomy. DESIGN: Retrospective, noncomparative, consecutive case series. METHODS: The medical records were reviewed of all patients who developed acute-onset postoperative endophthalmitis (within 6 weeks of surgery) after pars plana vitrectomy at Bascom Palmer Eye Institute between January 1, 1984 and December 31, 2003. RESULTS: During the 20-year study interval, the overall incidence rate of postvitrectomy endophthalmitis was 0.039% (6/15,326). Cultured organisms were Staphylococcus aureus (n = 3), Proteus mirabilus (n = 1), and Staphylococcus epidermidis/Pseudomonas aeruginosa (n = 1); one case was culture-negative. Visual acuity after treatment for endophthalmitis ranged from 2/200 to no light perception, with a final vision of light perception or no light perception in four of six (67%) eyes. CONCLUSION: The incidence of endophthalmitis after pars plana vitrectomy is low but the visual acuity outcomes after treatment are generally poor.

Acute-onset postoperative endophthalmitis: review of incidence and visual outcomes (1995-2001).

BACKGROUND AND OBJECTIVE: To determine the incidence rate of acute-onset postoperative endophthalmitis and to assess visual acuity outcomes after treatment from the most recent 7 years (1995-2001) compared with the previous 11 years (1984-1994) among patients undergoing intraocular surgery at the same institution. PATIENTS AND METHODS: The medical records were reviewed of all patients undergoing intraocular surgery at the Bascom Palmer Eye Institute between January 1, 1995 and December 31, 2001. RESULTS: The 7-year incidence rate of acute-onset postoperative endophthalmitis was 0.05% (17 of 35,916 intraocular surgeries). The number of patients with endophthalmitis (incidence) and their median final visual acuity for each surgical category are as follows: cataract extraction: 8/21,972 (0.04%) - 20/100; glaucoma surgery: 4/1,970 (0.2%) - 20/70; penetrating keratoplasty: 2/2,362 (0.08%) - light perception; pars plana vitrectomy: 2/7,429 (0.03%) - hand movements; secondary intraocular lens placement: 1/485 (0.2%) - 20/40. Of the 8 cases of endophthalmitis after cataract surgery, 6 cases occurred after phacoemulsification and 2 of these cases had a dear corneal sutureless incision. CONCLUSION: The most recent 7-year incidence rate of acute-onset postoperative endophthalmitis is significantly lower than that of the previous 11 years (0.05% versus 0.09%; = 0.031) at the same institution. Visual acuity outcomes after treatment were generally better in cataract surgery, glaucoma surgery, and secondary intraocular lens categories compared to pars plana vitrectomy and penetrating keratoplasty categories.