Postoperative endophthalmitis: establishment and results of a national registry

Abstract 

Purpose

To determine the incidence, clinical presentation, etiology, and outcomes of postoperative endophthalmitis in Norway and to explore the potential of and establish a platform for improving diagnostics, prophylaxis, and treatment of postoperative endophthalmitis.

Setting

All ophthalmic surgical units and relevant microbiology laboratories in Norway.

Methods

A national registry of cases of postoperative endophthalmitis was established in 1996. All ophthalmic surgery units in Norway were asked to return forms including preoperative, perioperative, and postoperative data for each case of endophthalmitis occurring between January 1996 and December 1998 after any intraocular surgery irrespective of the time between the surgery and the onset of endophthalmitis symptoms. All microbiology laboratories in Norway were asked to return questionnaires regarding their routine handling procedures of eye specimens in cases of endophthalmitis.

Results

From 1996 to 1998, 111 suspected endophthalmitis cases were reported, all after cataract surgery. Eighty cases were culture positive, 75 with gram-positive bacteria, 4 with gram-negative bacteria, and 1 with Candida albicans. Depending on the definition, the incidence of postoperative endophthalmitis was between 0.11% and 0.16%. Thirteen percent of cases had “delayed” endophthalmitis. Twenty-nine percent of eyes had an outcome of permanent amaurosis or light perception visual acuity; 56% (47/84) retained or improved their categorized visual acuity in the affected eye compared to preoperatively. Positive bacterial growth was associated with a worse visual outcome (P = .008). The degree of inflammation when endophthalmitis was diagnosed and the visual outcomes were worse in cases with growth of streptococci than in cases with growth of staphylococci (P = .009 and P<.001, respectively). The questionnaire to the microbiology laboratories revealed a lack of consensus on how to handle the specimens.

Conclusions

Postoperative endophthalmitis remains a serious complication of intraocular surgery, although the prognosis depends greatly on the microbe isolated. Common guidelines should be established regarding clinical and microbiological diagnosis and treatment. Further improvement of the registry would make it a suitable platform for evaluating prophylactic treatments.