Clinical features and treatment of endophthalmitis after cataract surgery

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PURPOSE

The study analyzes the frequency of acute endophthalmitis occurrence after cataract surgery, the risk factors, characteristic symptoms, and the effectiveness of peri-operative prevention measures.

MATERIAL AND METHODS

The study retrospectively analyzed 59 670 cases of patients operated for cataract in 2017—2021. To prevent infections, patients received four instillations of third generation fluoroquinolone (quinolone antibiotic) in the course of two days prior to cataract phacoemulsification (PE), and two instillations immediately (1 hour and 30 minutes) before the surgery; three-minutes treatment of the cornea, conjunctival sac and periocular skin with 5% povidone iodine before the surgery; and as the last step of surgery, patients received subconjunctival injection of 0.05 g cefazolin with 2 mg dexamethasone. Follow-up after surgery included four injections of 0.5% levofloxacin in the course of 7—10 days, and 0.1% dexamethasone for two weeks, or fixed combination of tobramycin and dexamethasone four times per day for two weeks. The criteria for acute endophthalmitis are: loss of spatial vision, absence of red reflex, pronounced thickening of the choroid, suspended particulates in the retrovitreal space and the vitreous observed with ultrasonography in the early postoperative period (day 4—7 after surgery).

RESULTS AND DISCUSSION

There were 32 patients (0.054%) diagnosed with acute endophthalmitis. Posterior capsule rupture was the main complicative risk factor of endophthalmitis development (OR=11.75, p=0.026). Main diagnostic criteria of acute endophthalmitis were hypopyon (OR=22.5, p=0.001) and absence of red reflex (OR=19.59, p<0.001). The use of the fixed combination of tobramycin and dexamethasone was associated with 5.8-times higher risk of acute endophthalmitis than separate application of levofloxacin and dexamethasone (p=0.042).

CONCLUSIONS

Povidone iodine and third generation fluoroquinolone as a method of acute endophthalmitis prevention after cataract surgery demonstrate comparable efficacy to intracameral antibiotic injections.

Keywords:

endophthalmitis

phacoemulsification

vitrectomy

hypopyon

posterior capsule rupture

intraocular lens

cataract

complications

antibiotic prophylaxis

Authors:

Nikolaenko V.P.

City Multidisciplinary Hospital No. 2;
Saint Petersburg State University

Belov D.F.

Saint Petersburg Multifield Hospital No. 2

Received:

07.02.2023

Accepted:

20.03.2023

List of references:

Sharma B, Abell RG, Arora T, et al. Techniques of anterior capsulotomy in cataract surgery. Indian J Ophthalmol. 2019;67(4):450-460. https://doi.org/10.4103/ijo.IJO_1728_18
Pancholy M, Storey PP, Levin HJ, et al. Endophthalmitis following intravitreal antivascular endothelial growth factor therapy: changes in incidence and outcomes over a 9-year period. Curr Eye Res. 2021;46(9):1370-1377. https://doi.org/10.1080/02713683.2021.1874023
Durand ML. Endophthalmitis. Clin Microbiol Infect. 2013;19(3):227-234. https://doi.org/10.1111/1469-0691.12118.
Astakhov YuS, Nikolaenko VP. Oftal’mologiya. Farmakoterapiya bez oshibok [Ophthalmology. Pharmacotherapy without mistakes]. M.: E-noto; 2021. (In Russ.).
Barry P, Cordoves L, Gardner S. ESCRS guidelines for prevention and treatment of endopthalmitis following cataract surgery. Co Dublin: Temple House, Temple Road, Blackrock; 2013;1-22.
López-Cabezas C, Muner DS, Massa MR, et al. Antibiotics in endophthalmitis: microbio-logical and pharmacokinetic considerations. Curr Clin Pharmacol. 2010;5(1):47-54. https://doi.org/10.2174/157488410790410597
Nikolaenko VP, Belov DF. Antibiotic prophylaxis of acute postoperative endophthalmitis. Russian Journal of Clinical Ophthalmology = Klinicheskaya oftal’mologiya. 2021;21(4):220-226. (In Russ.). https://doi.org/10.32364/2311-7729-2021-21-4-220-226
Conrady CD, Feist RM Jr, Vitale AT, et al. Long-term visual outcomes of endophthalmitis and the role of systemic steroids in addition to intravitreal dexamethasone. BMC Ophthalmol. 2020;20(1):181. https://doi.org/10.1186/s12886-020-01449-2
Robbins CB, Ma J, Feng HL, et al. Clinical decision making and visual outcomes in endophthalmitis treated with systemic corticosteroids. Ophthalmol Retina. 2020;4(11):1103-1108. https://doi.org/10.1016/j.oret.2020.04.026
Endophthalmitis Vitrectomy Study Group. Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol. 1995;113:1479-1496.
Kresloff MS, Castellarin AA, Zarbin MA. Endophthalmitis. Surv Ophthalmol. Nov-Dec 1998;43(3):193-224. https://doi.org/10.1016/s0039-6257(98)00036-8
Pijl BJ, Theelen T, Tilanus MA, et al. Acute endophthalmitis after cataract surgery: 250 consecutive cases treated at a tertiary referral center in the Netherlands. Am J Ophthalmol. 2010;149(3):482-487.e1-2. https://doi.org/10.1016/j.ajo.2009.09.021
Pirogov YuI, Shustrova TA, Oblovatskaya ES, Khromova ES. Effect of perioperative antibacterial prophylaxis using eye drops with fluoroquinolones on conjunctival microflora in patients before and after phacoemulsification. Ophthalmology in Russia = Oftal’mologiya. 2020;17(1):111-116. (In Russ.). https://doi.org/10.18008/1816-5095-2020-1-111-116
Guo HP, Wang TJ. Fulminant Serratia marcescens panophthalmitis. Am J Med Sci. 2017;353(4):e7. https://doi.org/10.1016/j.amjms.2016.09.005
Pershing S, Lum F, Hsu S, et al. Endophthalmitis after cataract surgery in the United States: A report from the intelligent research in Sight Registry, 2013—2017. Ophthalmology. 2020;127(2):151-158. https://doi.org/10.1016/j.ophtha.2019.08.026
Thanigasalam T, Sahoo S, Ali MM. Posterior capsule rupture with/without vitreous loss during phacoemulsification in a hospital in Malaysia. Asia Pac J Ophthalmol (Phila). 2015;4(3):166-170. https://doi.org/10.1097/APO.0000000000000056
Kim SH, Yu MH, Lee JH, et al. Endophthalmitis after cataract surgery in Korea: A Nation-wide study evaluating incidence and risk factors in a Korean population. Yonsei Med J. 2019;60(5):467-473. https://doi.org/10.3349/ymj.2019.60.5.467
Sheng Y, Sun W, Gu Y, et al. Endophthalmitis after cataract surgery in China, 1995—2009. J Cataract Refract Surg. 2011;37(9):1715-1722. https://doi.org/10.1016/j.jcrs.2011.06.019
Yao K, Zhang Z, Yang YH, Wu XD. Aqueous humor penetration of topically applied ofloxacin, ciprofloxacin and tobramycin. Zhonghua Yan Ke Za Zhi. 2003;39(12):736-739.
Luthardt K, Beck R, Hehl EM, et al. Hornhautpenetration verschiedener Aminoglycoside und Chinolone [Corneal penetration of various aminoglycosides and quinolones]. Klin Monbl Augenheilkd. 1998;213(3):141-146. https://doi.org/10.1055/s-2008-1034964
Bandello F, Coassin M, Di Zazzo A, et al. One week of levofloxacin plus dexamethasone eye drops for cataract surgery: an innovative and rational therapeutic strategy. Eye (Lond). 2020;34(11):2112-2122. https://doi.org/10.1038/s41433-020-0869-1
Avetisov KS. Acoustic density of cataracts. Russian Annals of Ophthalmology = Vestnik Oftal’mologii. 2015;131(2):38-44. (In Russ.). https://doi.org/10.17116/oftalma2015131238-44
Potemkin VV, Goltsman EV. Cataract surgery in pseudoexfoliation syndrome. Ophthalmology Journal = Oftal’mologicheskiye vedomosti. 2020;13(1):37-42. (In Russ.). https://doi.org/10.17816/OV25739.
Singh S, Pardhan S, Kulothungan V, et al. The prevalence and risk factors for cataract in rural and urban India. Indian J Ophthalmol. 2019;67(4): 477-483. https://doi.org/10.4103/ijo.IJO_1127_17
Nishi O. Fibrinous membrane formation on the posterior chamber lens during the early postoperative period. J Cataract Refract Surg. 1988;14(1):73-77. https://doi.org/10.1016/s0886-3350(88)80068-3
Boyko EV, Danilichev VF, Sazhin TG. Enzymo-therapy of fibrinous syndrome. Ophthalmosurgery = Oftal’mokhirurgiya. 2005;3:25-29. (In Russ.).
Boyko EV, Danilichev VF, Kol’tsova SV. Experimental substantiation of the use of recombinant prourokinase and its immobilized forms for the treatment of postoperative fibrinoid syndrome in ophthalmology. Byulleten’ eksperimental’noy biologii i meditsiny. 1997;123(2):201-204. (In Russ.).
Boiko EV, Danilichev VF, Sazhin TG, et al. Comparison of the pharmacokinetics of recombinant prourokinase in non-invasive methods of administration (drops, electrophoresis, therapeutic contact lenses). RMZh. Klinicheskaya oftal’mologiya. 2017;18(4):213-218. (In Russ.).
Belov DF, Petukhov VP. Treatment approaches to postoperative fibrinoid syndrome after phacoemulsification. Ophthalmology Journal = Oftal’mologicheskiye vedomosti. 2022;15(3):19-27. (In Russ.). https://doi.org/10.17816/OV109480
Norris JW, Chirls IA, Santry JG, et al. Severe fibrinous reaction after cataract and intraocular lens implantation surgery requiring neodymium:YAG laser therapy. J Cataract Refract Surg. 1990;16(5):637-639. https://doi.org/10.1016/s0886-3350(13)80784-5

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