Purpose: To evaluate the incidence of presumed endophthalmitis following cataract surgery over a 5-year period in a busy ophthalmic hospital.
Setting: Ophthalmology unit in the Royal Victoria Eye and Ear Hospital, Dublin, Ireland.
Methods: A retrospective series of 8736 consecutive cases of cataract extraction with intraocular lens implantation carried out during a period of 5 years from 1997 to 2001 were studied. All cases requiring readmission due to suspected postoperative infection were investigated as part of the study.
Results: A total of 8763 patients had a cataract procedure. Forty three of them were readmitted with suspected endophthalmitis, giving a total suspected endophthalmitis rate of 0.5%. Of the 43 readmitted cases, 29 cases (67%) had hypopyon and 14 cases (32%) had fibrinous uveitis. Of those with hypopyon, 83% received intravitreal antibiotics. Of those with fibrinous uveitis, none received intravitreal antibiotics. There was a difference in the numbers achieving visual acuity of 6/12 or better between the 2 groups (33% and 14% of patients, respectively). In cases that had a vitreous biopsy, 10 (42%) were culture positive and of these, the most common organism found was Staphylococcus aureus (50%). Fourteen of the 43 cases (32.5%) that presented with fibrinous uveitis were treated with topical, subconjunctival, and systemic antibiotics with steroids. Visual acuity of 6/12 or better was achieved in 6 patients (14%).
Conclusions: The incidence of suspected endophthalmitis following cataract surgery in a 5-year period in a busy Irish ophthalmic unit was 0.49%. Culture-positive endophthalmitis was 0.1%, but only 56% of cases with presumed endophthalmitis had a vitreous biopsy performed. The visual outcome was better in patients who were treated with intravitreal antibiotics at the first sign of symptoms. These findings support the hypothesis that infection is the most likely cause of postoperative endophthalmitis and that it may present as hypopyon or fibrinous uveitis. Prompt investigation and treatment of such patients with a standard endophthalmitis protocol should be instituted to save vision.