Posters

An 18 years retrospective study of Incidence of Infectious postoperative endophthalmitis (IPOE) before and after using intracameral cefuroxime in phacoemulsification (cataract or refractive lensectomy)

Poster Details

First Author: A.Llovet-Rausell SPAIN

Co Author(s):    F. Llovet-Osuna   J. Ortega-Usobiaga   J. Fernandez-García   R. Bilbao-Calabuig   J. Baviera        

Abstract Details

Purpose:

To investigate incidence of endophtalmitis before an after using intracameral cefuroxime in a 18 years retrospective study on 215539 eyes who underwent phacoemulsification (cataract or refractive lensectomy) in a private institution.

Setting:

Clinica Baviera, Aier Eye Group, Spain

Methods:

In an uncontrolled retrospective observational study of all registered cases of infectious postoperative endophthalmitis (IPOE) over a period of 18 years and in 215539 eyes that underwent phacoemulsification (cataract or refractive lensectomy). The general protocol included: preoperative topical antibiotic and NSAIDs, antisepsis and eye disinfection (povidone iodine), and isolation of the eye area. Intracameral antibiotics were used routinely in all cases: in Group A (2002 to 2007) the Intracameral antibiotic was vancomycin in the intracameral irrigation flow (27705 eyes) and in Group B (2008 to 2019) directly intracameral cefuroxime (187834 eyes). Postoperative protocol included antibiotics, steroidal anti-inflammatory and non-steroidal topical.

Results:

IPOE presented 25 cases (0.011%): 5 in Group A (0.02439%), 20 in Group B (0.010%) (p 0.441). Cultures were positive in 10 cases: Group A (1 coribacterium, 1 streptococcus spp) and Group B (1 stafilococcus waneri, 1 enterococcus fecalis, 3 staphylococcus epidermidis, 2 propinobacterium acnes, 1 stachybotrys chartrum. The average age of the patients with IPOE was 65.2 + - 8.9 years, 11 male and 14 female. Risk factors: Diabetes mellitus 2 (4 cases), DR surgery (1 case), CPR / vitreous loss (5 cases). The average time of onset of symptoms was 7 days and to resolution was 127 days.

Conclusions:

The application of a correct operative protocol, the topical use of povidone iodine and intracameral antibiotic is effective in reducing the risk of postoperative infectious endophthalmitis in phacoemulsification (cataract or refractive lensectomy), especially cefuroxime. The risk of bilateral blinding HORV after prophylactic use of intracameral vancomycin led to its abandonment.

Financial Disclosure:

None