An update of acute endophthalmitis following cataract surgery

Abstract

Cataract surgery, despite significant advancements in techniques to ensure its effectiveness and safety, can still be associated with rare but serious complications. Postoperative endophthalmitis (POE), is the most feared complication and highlighted in consent forms for intraocular surgeries. A comprehensive literature search was conducted across multiple databases, identifying 1485 articles, with 14 studies meeting the inclusion criteria. Incidence rates of POE range from 0.01% to 10.88%, with gram-positive bacteria like Staphylococcus epidermidis most commonly involved, associated with good visual outcomes in 69.7% of cases. Infections by bacteria such as Pseudomonas aeruginosa and Acinetobacter baumannii, which thrive in higher temperatures, are on the rise and have a poor visual prognosis (21.4%). The likelihood of POE is lower with better posterior capsule integrity (P<0.05). Other risk factors include surgical volume, and environmental factors include temperature and humidity. Symptoms typically develop within the first week postsurgery, including eye pain, redness, and decreased vision. Intravitreal antibiotics and pars plana vitrectomy are recommended by Endophthalmitis Vitrectomy Study (EVS), some surgeons nowadays opt for complete and early vitrectomy for endophthalmitis (CEVE). However, these treatments may offer limited benefits for patients with poor initial visual acuity and infections caused by highly virulent bacteria. Intracameral cefuroxime is the preferred prophylaxis, but there is a notable shift toward using moxifloxacin due to the emergence of more virulent bacteria. This study highlights the necessity of prompt identification and updated strategies in risk management, prophylaxis, and early follow-up to prevent poor visual outcomes.

Access to Document

Other files and links

• Link to publication in Scopus

Fingerprint