Reducing the risk for endophthalmitis after cataract surgery: Population-based nested case-control study: Endophthalmitis Population Study of Western Australia sixth report
Accepted 25 October 2006.
Purpose
To characterize operative and nonoperative risks for the potentially blinding complication of endophthalmitis after cataract surgery.
Setting
Ophthalmology services for the whole state of Western Australia.
Methods
This retrospective population-based nested case-control study in Western Australia covered the period between 1980 and 2000. For each of the 205 cases of endophthalmitis, 4 time-matched controls were randomly selected from all cataract operations performed in the state. Conditional logistic regression was used to estimate multivariate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the risk factors of interest.
Results
Wound location, suturing the wound, and type of cataract operation did not affect the risk for postoperative endophthalmitis. Antibiotic prophylaxis reduced the risk, but only if given as a subconjunctival injection (OR, 0.46; 95% CI, 0.29-0.70). The risk for endophthalmitis was greater with same-day surgery (OR, 2.27; 95% CI, 1.52-3.41) than with admission the day before surgery. A concurrent eyelid procedure was a substantial risk. Surgeons within 2 years of obtaining specialist qualifications were more likely to have a case of endophthalmitis, although this was partly the result of more posterior capsule breaches. Posterior capsule breach increased the risk when it occurred in private hospitals (OR, 13.57; 95% CI, 4.00-45.99), but not in public hospitals.
Conclusions
Nonoperative as well as operative factors are important in the prevention of endophthalmitis. Subconjunctival injection of antibiotics appears to be beneficial for endophthalmitis prophylaxis. The model showed that active risk management strategies designed to optimize hospitalization and chemoprophylaxis may reduce the incidence of endophthalmitis by up to 81%.
From the Eye and Vision Epidemiology Research Group (Ng, Morlet, Bulsara, Semmens), School of Public Health, Curtin University, Bentley, Centre for Health Services Research (Ng, Bulsara, Semmens), School of Population Health, The University of Western Australia, Nedlands, and the Department of Ophthalmology (Morlet), Royal Perth Hospital, Perth, Australia
Corresponding author: Professor James Semmens, School of Public Health, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia.
No author has a financial or proprietary interest in any material or method mentioned.
This work was presented in part at the European Society of Cataract and Refractive Surgeons, Lisbon, Portugal, September 2005 and the Congress of the Royal Australian and New Zealand College of Ophthalmologists, Hobart, Australia, November 2005.
Funded by project grants 110250 and 303114, Australian National Health and Medical Research Council.
The staff of the Data Linkage Unit, Western Australian Department of Health, provided data. The following contributed to teamEPSWA: Michael Walsh, Sir Charles Gairdner Hospital; Ian Constable, Sir Charles Gairdner Hospital, St. John of God Hospital, Lions Eye Institute, and University of Western Australia; Ian McAllister, Royal Perth Hospital, St. John of God Hospital, Lions Eye Institute, and University of Western Australia; Christopher Kennedy, Fremantle Hospital and St. John of God Hospital; Timothy Isaacs, Royal Perth Hospital, St. John of God Hospital, Lions Eye Institute, and University of Western Australia; John Pearman, Royal Perth Hospital; D'Arcy Holman, School of Population Health and University of Western Australia; Jianghong Li, Telethon Institute for Child Health Research and University of Western Australia; Bridget Mullholland, Royal Perth Hospital; Ferenz Kosaras, Royal Perth Hospital.
ABSTRACT