Prevention of endophthalmitis after cataract surgery

Postoperative endophthalmitis (PE) is a rare but potentially vision threatening condition that needs prompt diagnosis and treatment. To minimize, or preferably, eradicate the event of postoperative endophthalmitis, we analyzed PE cases regarding their bacteriology and susceptibility to given intracameral (IC) prophylactic antibiotics (Abs) over time.

In Paper 1, 95 culture-positive cases of PE occurring after cataract operations in a large surgical unit 1990 - 2009 were analyzed in a retrospective chart study. We found that the use of cefuroxime prophylaxis intracamerally effectively reduced the rate of PE from 0.18% (with no IC cefuroxime) to 0.04% (with IC cefuroxime), p < 0.001. Although the prophylaxis effectively prevented staphylococcal infections, we saw a rise in the rate of enterococci and gram-negatives, p=0.05.

In Paper 2, the incidence of PE in unilateral compared to immediate sequential bilateral cataract surgery (ISBCS) was analyzed from data of the Swedish National Cataract Register (NCR) from 2002 - 2017. The rate of PE in ISBCS was found to be lower than that of unilateral surgeries, p = 0.01. We believe that the reassuring results can be explained by the selection of patients being less prone to develop PE, but possibly also by the preferred use of the combination of ampicillin + cefuroxime as intracameral prophylaxis in ISCBS patients.

In Paper 3, the 2011 - 2017 database of the NCR was investigated to compare the PE rates and bacteriology of the three most used intracameral antibiotic regimes: cefuroxime, moxifloxacin and the combination of ampicillin + cefuroxime. There were no significant differences in the incidence of PE between the three antibiotic groups, but enterococcal infections were statistically significantly reduced by the two alternative treatments regimes in comparison to cefuroxime alone, p < 0.01.

List of scientific papers

I. Friling, E. & Montan, P. (2018). Bacteriology and cefuroxime- resistance in endophthalmitis following cataract surgery before and after the introduction of prophylactic intracameral cefuroxime: a retrospective single-centre study. Journal of Hospital Infection.
https://doi.org/10.1016/j.jhin.2018.02.005

Il. Friling, Emma & Johansson, Björn & Lundstrom, Mats & Montan, Per. (2021). Postoperative Endophthalmitis in Immediate Sequential Bilateral Cataract Surgery: A Nationwide Registry Study. Ophthalmology. 129. https://doi.org/10.1016/j.ophtha.2021.07.007

III. Friling, Emma & Bro, Tomas & Lundstrom, Mats & Montan, Per. (2024). Endophthalmitis following cataract surgery and effect of different intracameral antibiotic regimes in Sweden 2011 - 2017. A national registry study. Journal of Cataract and Refractive Surgery.
https://doi.org/10.1097/j.jcrs.0000000000001464