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Perspective
Current approach to postoperative endophthalmitis
  1. GORDANA SUNARIC-MÉGEVAND,
  2. CONSTANTIN J POURNARAS
  1. Clinique Universitaire d’Ophtalmologie, Rue Alcide-Jentzer 22, 1205 Genève, Switzerland
  1. Gordana Sunaric-Mégevand, MD.

https://doi.org/10.1136/bjo.81.11.1006

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    Endophthalmitis is a rare complication, potentially the most devastating, of intraocular surgery or trauma. Despite major advances in asepsis, surgical technique and antibiotic therapy, it remains a major concern for any ocular surgeon. Its prevention by meticulous clinical evaluation of preoperative risk factors, accurate surgical procedure, pre- and peroperative antibiotic prophylaxis is one of our first goals. In some cases, however, the infection will occur; only prompt diagnosis and adequate treatment can successfully restore visual acuity.

    This review summarises some relevant notions about the incidence, the causative organisms, and predisposing factors, with particular emphasis on the prophylaxis and various treatment modalities.

    Incidence

    Over the past decade, there has been a decline in the incidence of postoperative endophthalmitis, owing to the improvement of modern surgery, instrumentation, sterility, and prophylactic antibiotics. Generally accepted as approximately 10% at the beginning of the century,1 the incidence today ranges from 0.3% (prospective study realised in 1989 in France)2 down to 0.07% (retrospective American study reporting data from 1984 to 1989).3

    Incidence seems to depend on the type of surgery. After extracapsular lens extraction (ECLE) or phacoemulsification and intraocular lens (IOL),34 it is between 0.07% and 0.12% (Table 1). After secondary IOL implantation, it is higher (0.3%), probably related to greater manipulation. Endophthalmitis immediately following trabeculectomy is rare (0.6%), with an apparent higher incidence of late onset endophthalmitis (1.8%) occurring from 3 months to 27 years postoperatively.5 Of particular concern is the high incidence of rapidly progressing and devastating late onset endophthalmitis after the use of the antimetabolites 5-fluorouracil (5–8%)67 and mitomycin C (MMC) (2.7–3%).89

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    Table 1

    Incidence of postoperative endophthalmitis

    In a large study (27 181 eyes) of sutureless cataract extraction after conventional ECLE or phacoemulsification, an incidence of only 0.015% has been reported.10

    Olson has postulated that …

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