Incidence of post-cataract endophthalmitis at Aravind Eye Hospital: Outcomes of more than 42 000 consecutive cases using standardized sterilization and prophylaxis protocols
Received 28 November 2008; received in revised form 9 January 2009; accepted 12 January 2009.
Purpose
To report the incidence of postoperative endophthalmitis at a high-volume eye hospital in southern India using a modified cost-effective sterilization protocol.
Setting
Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India.
Methods
In this retrospective observational series at a single eye hospital, records of patients who had cataract surgery using a modified sterilization protocol from January 2007 through August 2008 and developed postoperative endophthalmitis within the first 3 postoperative months were drawn from a computerized database. The patient's socioeconomic status, the surgeon's experience, and the type of cataract procedure performed were analyzed as possible risk factors using the chi-square test/Fischer exact test.
Results
During the study period, 42426 cataract surgeries were performed. From these, 38 cases of presumed postoperative endophthalmitis were identified (incidence 0.09%). Thirty-five of the 38 cases were in the manual large- and small-incision extracapsular cataract extraction (ECCE) group, which had a statistically higher rate than the phacoemulsification group (P = .016). There was no statistical difference in the endophthalmitis rates between private patients and charity patients for either surgical method (manual ECCE or phacoemulsification).
Conclusions
The modified sterilization and asepsis protocol adopted to facilitate high-volume cataract surgery in a clinical setting appeared to be safe and effective in preventing postsurgical endophthalmitis. Despite a 3:1 ratio of manual ECCE to phacoemulsification and the elimination of certain traditional sterilization practices, the rate of endophthalmitis in this generally underserved patient population with multiple risk factors for infection was comparable to that reported in other modern settings.
From Aravind Eye Hospital and the Post Graduate Institute of Ophthalmology (Ravindran, Venkatesh, Sengupta, Gyatsho, Talwar), Pondicherry, India, and a private practice (Chang), Los Altos, California, USA
Corresponding author: Dr. Ravilla D. Ravindran, MS, DO, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry–605007, India.
No author has a financial or proprietary interest in any material or method mentioned.
M. Selvarani, Priya Paulraj, G. Rekha, P.R. Nagalakshmi, Aravind Eye Hospital, Pondicherry, collected data. Nithya Neelakantan, Biostatistician, Aravind Eye Care System, Madurai, helped analyze the data.
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