Abstract

DO.12.11

Endophthalmitis after cataract surgery – results of a German survey

Kurz S.¹, Nameh A.¹, Victor A.², Pfeiffer N.^1
1Universitäts-Augenklinik Mainz; ²IMBEI Mainz

Objective: Endophthalmitis after cataract surgery is a dreaded condition in ophthalmology. The goal of this survey was to document perioperative prophylactic treatment and to evaluate the risk factors for endophthalmitis after cataract surgery. Furthermore, we compared the results with our survey in 1996.
Methods: 619 centers in Germany were queried for 2006.
Results: A total of 349 (56,4%) questionnaires were received, with each center reporting an average of 1067 cataract surgeries per year (total, 351168 surgeries in 2006). Respondents reported a total of 112 cases of endophthalmitis, which resulted in a mean responder-specific endophthalmitis rate of 0.003%. Statistical analysis via Poisson regression suggested that outpatient surgery, performed in >90%, were associated with a reduced incidence of endophthalmitis in contrast to inpatient surgery, when performed >30% (relative risk (RR) 1,76, 95% confidence interval (CI) 1,15-2,7). Coaxial phacoemulsification was used most often (89%), biaxial phacoemulsification in 11%. The main incision was 2,8-3,2 mm (60%) in width, followed by 2,2 – 2,8 mm (32%). 58% of the centers performed surgery via clear corneal incision versus 42% sclerocorneal. Sclerocorneal incisions were associated with a trend towards a reduced risk of postoperative infection (RR 0,62, 95% CI 0,4-0,95, p=0,028). 93% of the surgeons used diluted povidone-iodine on the conjunctiva. The concentration of the iodine (1-10%) had no effect on the endophthalmitis rate (p=0,243). Missing of intraocular antibiotics added to the infusate was associated with a 1,4x elevated risk to develop postoperative infection (RR 1,39, 95% KI 0,96-2,03). Infusion of the anterior chamber using an antibiotic drug was associated with a protective effect (RR 0,4).
Conclusions: Comparing the results to our survey in 1996, we documented the following differencies: Rising surgery centers and surgeries, reduction of endophthalmitis cases, trend towards microincion, application of povidone-iodine on the conjunctiva as standard. Sclerocorneal incision as well as the use of intraocular antibiotics still seem to have a protecting effect on the development of postoperative infection.

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