Incidence of postoperative endophthalmitis from 1990 to 2009 using povidone–iodine but no intracameral antibiotics at a single academic institution

• Published in: Journal of cataract and refractive surgery Vol. 41; no. 1; pp. 58 - 66
• Main Authors: Nentwich, Martin M., MD, Ta, Christopher N., MD, Kreutzer, Thomas C., MD, Li, Bing, MD, Schwarzbach, Fabian, MD, Yactayo-Miranda, Yazmin M., MD, Kampik, Anselm, MD, Miño de Kaspar, Herminia, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2015
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anterior Chamber - drug effects; Anti-Bacterial Agents - therapeutic use; Anti-Infective Agents, Local - administration & dosage; Bacteria - isolation & purification; Cataract Extraction; Child; Child, Preschool; Endophthalmitis - diagnosis; Endophthalmitis - epidemiology; Endophthalmitis - microbiology; Eye Infections - diagnosis; Eye Infections - epidemiology; Eye Infections - microbiology; Female; Fungi - isolation & purification; Humans; Incidence; Infant; Male; Middle Aged; Ophthalmology; Postoperative Complications; Povidone-Iodine - administration & dosage; Pre-Exposure Prophylaxis; Retrospective Studies
• ISSN: 0886-3350; 1873-4502
• DOI: 10.1016/j.jcrs.2014.04.040

Purpose To correlate the incidence of postoperative endophthalmitis with changes in the preoperative prophylaxis over a 20-year period. Setting Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany. Design Retrospective chart review. Methods Patients diagnosed with postoperative endophthalmitis from 1990 to 2009 after intraocular surgery performed at the same institution were included. Because of changes in the preoperative prophylaxis during the study period, 3 groups were formed for data analysis: Period 1 (1990 to 1992), no standardized prophylaxis regimen; period 2 (1993 to 1998), preoperative topical medication, povidone–iodine 10.0% periorbitally, and 1 drop of povidone–iodine 1.0% in the conjunctiva sac; and period 3 (1999 to 2009), similar to period 2 except with irrigation of the conjunctival sac with 10 mL of povidone–iodine 1.0%. Results The overall rate of postoperative endophthalmitis was 0.113% (77/68 323) for all intraocular surgeries. It decreased significantly from 0.291% (16/5505) in period 1 to 0.170% (33/19 413) in period 2 to 0.065% (28/43 405) in period 3 ( P  < .001). In cataract surgery, the overall rate of postoperative endophthalmitis was 0.125% (30/24 034). It decreased in each subsequent period, from 0.338% (9/2662) in period 1 to 0.224% (15/6696) in period 2 to 0.041% (6/14 676) in period 3 ( P  < .001). Coagulase-negative Staphylococcus was the most commonly isolated organism (47.4%). Conclusions The rate of postoperative endophthalmitis decreased over a 20-year period at a single academic institution. Although multiple factors might have contributed to this decline, implementation of a preoperative prophylaxis protocol using copious povidone–iodine might have been the most important contributor. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.