Acute-onset endophthalmitis after cataract surgery (2000-2004): Incidence, clinical settings, and visual acuity outcomes after treatment

PURPOSE: To report the incidence, clinical settings, and visual acuity outcomes of acute-onset endophthalmi. tis after cataract surgery. DESIGN: Retrospective, observational case series. METHODS: Annual cataract surgery statistics were determined by review of electronic surgical records. The clinical and microbiologic records were reviewed of all patients with clinically diagnosed endophthalmitis within 6 weeks after cataract surgery at a single university-affiliated hospital between January 2000 and November 2004. MAIN OUTCOME MEASURES: Operative technique, intraoperative complications, and visual acuity. RESULTS: The incidence of acute-onset endoph, thalmitis after cataract surgery was 0.04% (7/15,920) for cataract surgeries of all methods, 0.05% (6/11,462) for cataract surgery by clear cornea phaco-emulsification, and 0.02% (1/4,458) for cataract surgery by methods other than clear cornea phaco-emulsification (P =.681, Fisher's exact test). Six of seven (86%) cases occurred in the right eye, and all cases were performed by right,handed surgeons through temporal incisions. Five of seven (71%) patients had relative immune compromise. Four of seven (57%) patients had an intraoperative complication: vitreous loss in three patients and iris prolapse in one patient. Two patients had. topical placement of lidocaine 2% gel before povidone-iodine preparation. The visual acuity at final follow up was 20/25 or better in four patients and count fingers or worse in three patients. CONCLUSIONS: The incidence of acute-onset endophthalmitis after temporal clear cornea incision phacoemul, sification is low (0.05%). Potential risk factors for endophthalmitis may include intraoperative complications, relative immune compromise, application of lido, caine 2% gel before povidone-iodine preparation, and inferior incision location. (c) 2005 by Elsevier Inc. All rights reserved.