Endophthalmitis in cataract surgery - Results of a German survey

Objective: To document perioperative prophylactic treatment and to evaluate the risk factors for endophthalmitis after cataract surgery. Design: Cross-sectional study via anonymous survey. Participants: Four hundred sixty-nine centers in Germany were queried. Results: A total of 311 (67%) questionnaires were received, with each cente r reporting an average of 900 cataract surgeries per year (total, 340,633 s urgeries in 1996). Respondents reported a total of 267 cases of endophthalm itis, which resulted in a mean responder-specific endophthalmitis rate of 0 .148% versus a median rate of 0%. Statistical analysis via Poisson regressi on suggested that sclerocorneal incisions were associated with a reduced in cidence of endophthalmitis (odds ratio, 0.35; 95% confidence interval, 0.24 -0.51). Antibiotics used intraocularly (odds ratio, 0.65; 95% confidence in terval, 0.43-0.98) and the preoperative application of diluted povidone-iod ine on the conjunctiva (odds ratio, 0.59; 95% confidence interval, 0.36-0.9 9) were associated with a reduced risk of postoperative infection. Immune d eficiencies (66%), diabetes mellitus (62%), occlusion of the lacrimal syste m (40%), and skin diseases (33%) were regarded as risk factors for endophth almitis by the respondents. When cataract surgery is performed solely under inpatient conditions, the use of systemic antibiotics as well as the perio cular injection of antibiotics at the end of the operation were associated (although not significantly) with a trend toward reducing the incidence of postoperative infection. Conversely, flushing the lacrimal drainage system, using eye shields, and cutting the eyelashes had no demonstrable effect in preventing endophthalmitis. The use of preoperative topical antibiotics (o dds ratio, 2.38; 95% confidence interval, 1.21-4.68) and the performance of more than 20% of the surgeries in an outpatient center (odds ratio, 2.0; 9 5% confidence interval, 1.24-3.21) were associated with a detrimental effec t on the development of endophthalmitis. Conclusions: Although the appropriate antibiotic agent and dosage are not y et established, the administration of intracameral antibiotics and the appl ication of povidone-iodine on the conjunctiva significantly reduced the rel ative risk of postoperative endophthalmitis in this survey. Because the stu dy was not individual based but rather on aggregate questionnaire, the resu lts have to be interpreted with care.