Acute-onset nosocomial endophthalmitis after cataract surgery: Incidence, clinical features, causative organisms, and visual outcomes
Received 2 December 2008; accepted 1 January 2009.
Purpose
To estimate the incidence of acute-onset endophthalmitis after cataract surgery and to report its clinical features, microbiology, and final visual outcomes.
Setting
King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
Methods
This was a retrospective observational case series.
Results
The 10-year incidence of acute-onset endophthalmitis after cataract surgery was 0.068%: 0.049% for extracapsular cataract extraction (ECCE) and 0.085% for clear corneal phacoemulsification (P = .268). The incidence of endophthalmitis was 0.053% during the first 5 years of the study and 0.08% during the next 5 years. The most common presenting features were pain and poor red reflex. Of the 20 cases, 18 were culture positive. The culture isolates showed Staphylococcus species in 7 eyes (35%), Streptococcus species in 7 eyes (35%), polymicrobial or mixed infections in 3 eyes (15%), and Propionibacterium acnes in 1 eye (5%). Two patients (10%) achieved a final visual acuity of 20/40 or better, 5 (25%) had worse than 20/40 to better than 20/200, and 8 (40%) had worse than 20/200; 5 eyes (25%) were eviscerated. Visual outcomes were good in endophthalmitis cases after phacoemulsification and in cases caused by Staphylococcus epidermidis and worse in cases that had Streptococcus species endophthalmitis.
Conclusions
Clear corneal phacoemulsification had a 1.73-fold higher risk for acute endophthalmitis than ECCE. Although the incidence of endophthalmitis after ECCE was lower than after phacoemulsification, the outcome was much worse in post-ECCE endophthalmitis cases. Poor visual outcomes were associated with more virulent organisms and delayed presentation.
From the Department of Ophthalmology (Al-Mezaine) and Research Department (Kangave), College of Medicine, King Saud University, and the Anterior Segment Division (Al-Assiri, Al-Rajhi), and Research Department (Al-Rajhi), King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
Corresponding author: Hani S. Al-Mezaine, MD, Anterior Segment Division, King Abdulaziz University Hospital, PO Box 230387, Riyadh 11321, Saudi Arabia.
No author has a financial or proprietary interest in any material or method mentioned.
ABSTRACT