Prophylaxis of postoperative endophthalmitis following cataract surgery: Results of the ESCRS multicenter study and identification of risk factors

• Published in: Journal of cataract and refractive surgery Vol. 33; no. 6; pp. 978 - 988
• Main Author: ESCRS Endophthalmitis Study Group
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2007; Elsevier Science
• Subjects: Aged; Anterior Chamber - drug effects; Anti-Bacterial Agents - therapeutic use; Antibiotic Prophylaxis; Biological and medical sciences; Cefuroxime - therapeutic use; Endophthalmitis - epidemiology; Endophthalmitis - etiology; Endophthalmitis - prevention & control; Eye Infections, Bacterial - epidemiology; Eye Infections, Bacterial - etiology; Eye Infections, Bacterial - prevention & control; Female; Humans; Incidence; Lens diseases; Lens Implantation, Intraocular; Levofloxacin; Male; Medical sciences; Odds Ratio; Ofloxacin - therapeutic use; Ophthalmology; Phacoemulsification; Postoperative Complications - prevention & control; Prospective Studies; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Postoperative; Cataract; Multicenter study; Uvea disease; Identification; Prevention; Eye disease; Lens disease; Treatment; Surgery; Risk factor; Ophthalmology; Endophtalmitis; Anterior segment disease
• ISSN: 0886-3350; 1873-4502
• DOI: 10.1016/j.jcrs.2007.02.032

Purpose To identify risk factors and describe the effects of antibiotic prophylaxis on the incidence of postoperative endophthalmitis after cataract surgery based on analysis of the findings of the European Society of Cataract & Refractive Surgeons (ESCRS) multicenter study. Setting Twenty-four ophthalmology units in Austria, Belgium, Germany, Italy, Poland, Portugal, Spain, Turkey, and the United Kingdom. Methods A prospective randomized partially masked multicenter cataract surgery study recruited 16 603 patients. The study was based on a 2 × 2 factorial design, with intracameral cefuroxime and topical perioperative levofloxacin factors resulting in 4 treatment groups. The comparison of case and non-case data was performed using multivariable logistic regression analyses. Odds ratios (ORs) associated with treatment effects and other risk factors were estimated. Results Twenty-nine patients presented with endophthalmitis, of whom 20 were classified as having proven infective endophthalmitis. The absence of an intracameral cefuroxime prophylactic regimen at 1 mg in 0.1 mL normal saline was associated with a 4.92-fold increase (95% confidence interval [CI], 1.87-12.9) in the risk for total postoperative endophthalmitis. In addition, the use of clear corneal incisions (CCIs) compared to scleral tunnels was associated with a 5.88-fold increase (95% CI, 1.34-25.9) in risk and the use of silicone intraocular lens (IOL) optic material compared to acrylic with a 3.13-fold increase (95% CI, 1.47-6.67). The presence of surgical complications increased the risk for total endophthalmitis 4.95-fold (95% CI, 1.68-14.6), and more experienced surgeons were more likely to be associated with endophthalmitis cases. When considering only proven infective endophthalmitis cases, the absence of cefuroxime and the use of silicone IOL optic material were significantly associated with an increased risk, and there was evidence that men were more predisposed to infection (OR, 2.70; 95% CI, 1.07-6.8). Conclusions Use of intracameral cefuroxime at the end of surgery reduced the occurrence of postoperative endophthalmitis. Additional risk factors associated with endophthalmitis after cataract surgery included CCIs and the use of silicone IOLs.