Epidemiology of postoperative endophthalmitis in an Asian population: 11-year incidence and effect of intracameral antibiotic agents

J Cataract Refract Surg. 2012 Mar;38(3):425-30. doi: 10.1016/j.jcrs.2011.09.040. Epub 2012 Jan 15.


Purpose: To describe the incidence of postoperative endophthalmitis after cataract surgery in a multiethnic Asian population over an 11-year period, compare the endophthalmitis rates before and after the use of intracameral antibiotic agents, and identify potential risk factors for endophthalmitis.

Setting: Department of Ophthalmology, Tan Tock Seng Hospital, Singapore.

Design: Cohort study.

Methods: The incidence and risk factors for postoperative endophthalmitis in patients who had cataract surgery over 11 years were reviewed. Subconjunctival antibiotic agents only were administered over 7 years; in the subsequent 4 years, intracameral cefazolin (1.0 mg/0.1 mL) was used.

Results: The overall incidence of postoperative endophthalmitis in 50,177 was 0.042%. Over the 7 years without intracameral antibiotics, the endophthalmitis rate was 0.064% (19/29,539). With the use of intracameral cefazolin, the incidence decreased to 0.01% (2/20,638) (multivariate odds ratio [OR], 13.6; 95% confidence interval [CI], 3.15-58.58; P<.001). The independent risk factors for endophthalmitis were age (OR, 1.05; 95% CI, 1.01-1.09; P=.025) and male sex (0.06% versus 0.02%; OR, 2.96; 95% CI; 1.15-7.65; P=.025).

Conclusions: There was a significant reduction in the rate of postoperative endophthalmitis in a multiethnic Asian population with the use of intracameral cefazolin. Men and older patients were at a higher risk for endophthalmitis.

Financial disclosure: No author has a financial or proprietary interest in any material or method mentioned.

MeSH terms

  • Aged
  • Anterior Chamber
  • Anti-Bacterial Agents / administration & dosage*
  • Asian Continental Ancestry Group*
  • Bacteria / isolation & purification
  • Cataract Extraction*
  • Cefazolin / administration & dosage*
  • Endophthalmitis / epidemiology*
  • Endophthalmitis / microbiology
  • Eye Infections, Bacterial / epidemiology*
  • Eye Infections, Bacterial / microbiology
  • Female
  • Humans
  • Incidence
  • Male
  • Odds Ratio
  • Postoperative Complications*
  • Risk Factors
  • Singapore / epidemiology
  • Visual Acuity / physiology


  • Anti-Bacterial Agents
  • Cefazolin