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Changing operating room practices: the effect on postoperative endophthalmitis rates following cataract surgery
  1. Aravind Haripriya1,
  2. Ravilla D Ravindran2,
  3. Alan L Robin3,4,
  4. Aakriti Garg Shukla5,
  5. David F Chang6
  1. 1 Cataract and Intraocular Lens Services, Aravind Eye Care System, Chennai, Tamil Nadu, India
  2. 2 Chairman & Director – Quality Division, Aravind Eye Care System, Madurai, Tamil Nadu, India
  3. 3 Ophthalmology, University of Michigan, Ann Arbor, Michigan, USA
  4. 4 Ophthalmology and International Health, Johns Hopkins University, Baltimore, Maryland, USA
  5. 5 Wills Eye Institute, Philadelphia, Pennsylvania, USA
  6. 6 Ophthalmology, UCSF, San Francisco, California, USA
  1. Correspondence to Dr David F Chang, UCSF, San Francisco, CA 94024, USA; dceye{at}; Dr Alan L Robin, Ophthalmology and International Health, Johns Hopkins University, Baltimore, Maryland, USA; arobin{at}


Purpose To determine whether four new operating room (OR) protocols instituted because of COVID-19 reduced the cataract surgical postoperative endophthalmitis rate (POE).

Design Retrospective, sequential, clinical registry study.

Methods 85 552 sequential patients undergoing cataract surgery at the Aravind Eye Hospitals between 1 January 2020 and 25 March 2020 (56 551 in group 1) and 3 May 2020 and 31 August 2020 (29 011 in group 2). In group 1, patients were not gowned, surgical gloves were disinfected but not changed between cases, OR floors were not cleaned between every case, and multiple patients underwent preparation and surgery in the same OR. In group 2, each patient was gowned, surgical gloves were changed between each case, OR floors and counters were cleaned between patients, and only one patient at a time underwent preparation and surgery in the OR.

Results Group 1 was older, had slightly more females, and better preoperative vision. More eyes in group 2 underwent phacoemulsification (p=0.18). Three eyes (0.005%) in group 1 and 2 eyes (0.006%) in group 2 developed POE (p=0.77). Only one eye that underwent phacoemulsification developed POE; this was in group 1. There was no difference in posterior capsule rupture rate between the two groups.

Conclusions Adopting a set of four temporary OR protocols that are often mandatory in the Western world did not reduce the POE rate. Along with previously published studies, these results challenge the necessity of these common practices which may be needlessly costly and wasteful, arguing for the reevaluation of empiric and potentially unnecessary guidelines that govern ophthalmic surgeries.

  • infection
  • eye (globe)
  • treatment surgery
  • public health

Data availability statement

Data are available on reasonable request. Not applicable.

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Data availability statement

Data are available on reasonable request. Not applicable.

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  • AH and RDR are joint first authors.

  • AH and RDR contributed equally.

  • ALR and DFC contributed equally.

  • Contributors All authors contributed equally to this study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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