Clinical observations associated with proven and unproven cases in the ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery

Barry, Peter; Gardner, Susanne; Seal, David; Gettinby, George; Lees, Fiona; Peterson, Magnus; Revie, Crawford; ESCRS Endophthalmitis Study Group,

doi:10.1016/j.jcrs.2009.03.049

« Previous Next »Journal of Cataract & Refractive Surgery
Volume 35, Issue 9 , Pages 1523-1531.e1, September 2009

Clinical observations associated with proven and unproven cases in the ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery

From Royal Victoria Eye and Ear Hospital (Barry), Dublin, Ireland; Applied Vision Research Centre (Seal), City University, London, United Kingdom; Department of Computer and Information Sciences, Department of Mathematics and Statistics (Gettinby, Lees, Peterson, Revie), University of Strathclyde, Glasgow, Scotland; Atlanta, Georgia, USA, (Gardner)

Received 12 February 2009; received in revised form 20 March 2009; accepted 24 March 2009.

Purpose

To describe cases of postoperative endophthalmitis in the European Society of Cataract & Refractive Surgeons (ESCRS) study of the prophylaxis of endophthalmitis, compare characteristics of unproven cases and cases proven by culture or polymerase chain reaction, and compare the characteristics with those in other reported series.

Setting

Twenty-four ophthalmology units in Austria, Belgium, Germany, Italy, Poland, Portugal, Spain, Turkey, and the United Kingdom.

Methods

Univariable and multivariable logistic regression models were used to analyze data for statistical association of signs and symptoms in cases with proven or unproven endophthalmitis. Specific data describing characteristics of the cases were compared between the 2 types of cases.

Results

Data from 29 endophthalmitis cases were analyzed. Swollen lids and pain were statistically associated with proven cases of endophthalmitis on univariable regression analysis. Multivariable analysis indicated that swollen lids and an opaque vitreous were associated with proven cases. Five cases of endophthalmitis occurred in the cefuroxime-treated groups. No case of streptococcal infection occurred in the cefuroxime-treated groups. However, cases of infection due to streptococci showed striking differences in visual acuity and were associated with earlier onset. Characteristics in the 29 cases parallel results in previous studies, such as the Endophthalmitis Vitrectomy Study, although the addition of a control group in the ESCRS study elicited additional findings.