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The incidence of postoperative endophthalmitis after cataract surgery in China: a multicenter investigation of 2006–2011
  1. Ke Yao1,2,
  2. Yanan Zhu1,2,
  3. Zhihong Zhu3,
  4. Jianjun Wu4,
  5. Yizhi Liu5,
  6. Yi Lu6,
  7. Yansheng Hao7,
  8. Yongzhen Bao8,
  9. Jian Ye9,
  10. Yusen Huang10,
  11. Zhaohui Li11,
  12. Xingchao Shentu1,2,
  13. Yibo Yu1,2
  1. 1Eye Center, 2nd Affiliated Hospital of Medical College, Zhejiang University, Hangzhou, Zhejiang, China
  2. 2Key Laboratory of Ophthalmology of Zhejiang Province, China
  3. 3Key Laboratory of Cardiovascular Diseases of Zhejiang Province, 2nd Affiliated Hospital of Medical College, Zhejiang University, Hangzhou, Zhejiang, China
  4. 4Department of Mathematics and Statistics, College of Science, Zhejiang University, Hangzhou, Zhejiang, China
  5. 5Zhongshan Ophthalmic Center, Guangzhou, Guangdong, China
  6. 6Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China
  7. 7Department of Ophthalmology, Third Hospital, Peking University, Beijing, China
  8. 8Department of Ophthalmology, People's Hospital of Peking University, Beijing, China
  9. 9Department of Ophthalmology, Da Ping Hospital, Third Military Medical University, Chongqing, China
  10. 10Shandong Eye Institute, Qingdao, China
  11. 11Department of Ophthalmology, 301 Military Hospital, Beijing, China
  1. Correspondence to Professor Ke Yao, Eye Center, 2nd Affiliated Hospital of Medical College, Zhejiang University, Hangzhou, Zhejiang 310009, China; xlren{at}zju.edu.cn

Abstract

Aims To estimate the cumulative incidence of postoperative endophthalmitis, identify risk factors and determine clinical outcomes in China.

Methods Medical records were reviewed for all patients with acute-onset endophthalmitis after cataract surgery from January 2006 to December 2011 at eight eye centres of tertiary care hospitals in China.

Results Sixty-six cases of presumed endophthalmitis occurred after 201 757 cataract surgeries, yielding a cumulative incidence of 0.033% (95% CI 0.025 to 0.041). Logistic regression analysis revealed that the risk of endophthalmitis increased with intraoperative communication with vitreous (multivariate OR 9.96; 95% CI 4.54 to 21.84; p<0.001). After a median follow-up of 153 days, best-corrected visual acuity in the affected eye was more than 20/70 in 29/65 (44.6%) patients, and more than 20/40 in 20/65 (30.8%). A predictor of good visual acuity was baseline acuity of counting fingers or better (OR 6.25; 95% CI 2.13 to 18.33). Of 64 cases, 25 (39.1%) were culture positive. Coagulase-negative Staphylococcus and Pseudomonas species were the most common organisms isolated, accounting for 72.0% of the culture-positive cases (18/25). Two eye centres that used a combination of a high concentration vancomycin (1 mg/0.1 mL intracameral vancomycin injection or 100 µg/mL vancomycin in irrigating solution) and tobramycin as infection prophylaxis achieved a lower incidence of endophthalmitis than other centres (p<0.001).

Conclusions The incidence of acute postoperative endophthalmitis after cataract surgery in tertiary care hospitals of China was 0.033%. Intraoperative communication with vitreous was a major risk factor for developing endophthalmitis. Prophylactic use of a high-concentration vancomycin and tobramycin may play a positive role in the prevention of postoperative endophthalmitis after cataract surgery.

  • Epidemiology

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