Endophthalmitis after cataract surgery: risk factors relating to technique and events of the operation and patient history: a retrospective case-control study.
OBJECTIVE
This study aimed to investigate the relationship between postoperative endophthalmitis and current changes in the cataract operative technique.


METHODS
A retrospective case-control study.


METHODS
The 22,091 cataract operations performed from 1990 through 1993 at St Eriks Hospital formed the basis for this investigation. In a random fashion, 220 control subjects were selected to be compared with the endophthalmitis cases.


METHODS
Numerous variables pertaining to the cataract extraction procedure and to the ocular and general health of patients with cataracts were analyzed regarding the development of postoperative intraocular infection. Patient age, presence of diabetes or immunosuppression, type of cataract extraction and intraocular lens (IOL), and intraoperative or postoperative complications were the principal variables assessed.


RESULTS
Fifty-seven patients with endophthalmitis were diagnosed, resulting in an overall frequency of 0.26%. Immunosuppressive treatment (P = 0.019), wound abnormality (P = 0.03), and the use of IOLs without a heparinized surface (P = 0.0023) were the only significant risk factors found in a logistic regression model.


CONCLUSIONS
The results suggest that cataract operating practice may alter the risk for endophthalmitis in that implanting a heparinized IOL and creating a tight section both seem to provide protection against this dreaded complication. Regarding patient history, an increased susceptibility was found among subjects treated with immunosuppressants. Designing a prophylactic protocol that protects against endophthalmitis more efficiently than did the study prophylaxis of 20 mg of subconjunctival gentamicin, is important not only for this patient subgroup but also for the cataract operated population at large.
Montan
P G
PG
Department of Ophthalmology, St Eriks Hospital, Stockholm, Sweden.
Koranyi
G
G
Setterquist
H E
HE
Stridh
A
A
Philipson
B T
BT
Wiklund
K
K
D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002387:Cataract Extraction / Q000009:adverse effects* / Q000379:methods*; D020099:Coated Materials, Biocompatible; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007431:Intraoperative Complications; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008297:Male; D011183:Postoperative Complications; D011897:Random Allocation; D012189:Retrospective Studies; D012307:Risk Factors
D020099:Coated Materials, Biocompatible; D005839:Gentamicins; D007166:Immunosuppressive Agents