Changes in rates of endophthalmitis after cataract surgery over the last 23years.

PURPOSE

Acute postoperative endophthalmitis (APE) is a rare but severe complication of cataract surgery. During the most recent decades, the use of povidone-iodine (PVI) before surgery combined with intracameral cefuroxime has drastically reduced the incidence of endophthalmitis. The goal of this study is to describe the changes in endophthalmitis rates after cataract surgery over the past two decades in a large tertiary ophthalmology center.

METHODS

A single-center retrospective descriptive study was conducted in the Quinze-Vingts National Ophthalmology Hospital (Paris, France). We included all eyes that underwent cataract surgery between 2000 and 2022. Cases of APE following cataract surgery were reported. The main outcome was the change in yearly incidence of APE. Rates were compared before and after the following events: application of a prophylactic protocol for local anesthesia, use of intracameral cefuroxime, and use of 2% lidocaine gel.

RESULTS

We included 178,752 cataract procedures in the study. A total of 49 cases of APE were reported between 2000 and 2022 (0.027%). Endophthalmitis rates progressively decreased, particularly after the introduction of intracameral cefuroxime in surgical practice in 2011. Since an adequate protocol for topical anesthesia was adopted, and intracameral cefuroxime was used systematically, rates of APE decreased and remained as low as 0.007% for the past decade, even though the number of yearly cataract procedures almost doubled.

CONCLUSION

The incidence of endophthalmitis after cataract surgery has significantly decreased over the past twenty-three years in our tertiary care center. The use of PVI before surgery along with systematic intracameral cefuroxime has allowed us to achieve very low rates of endophthalmitis.