Topical anaesthesia: a risk factor for post-cataract-extraction endophthalmitis?
OBJECTIVE
To investigate if the incidence of postoperative endophthalmitis in temporal clear corneal cataract surgery is influenced by the use of topical anaesthesia compared to retrobulbar anaesthesia.


METHODS
A retrospective study was conducted of one surgeon's cataract surgery between October 1997 and October 2001.


RESULTS
Between October 1997 and May 2000, there were 633 cataract extractions performed with 219 patients operated under topical anaesthesia and 414 under retro-bulbar injection. The selection criteria were that surgically easier cases underwent topical anaesthesia. There were five patients who suffered postoperative endophthalmitis in their first week, of which four cases were under topical anaesthesia. This was shown to be borderline significance of P = 0.05 using the Fischer exact 2-tailed test. There was a complicated case, operated under retrobulbar anaesthesia, who had a low-grade endophthalmitis in the second postoperative week. The four topical cases and the case from the second week all grew Staphylococcus epidermidis. The retrobulbar case developing endophthalmitis in the first week grew alpha haemolytic Streptococcus. After May 2000, there was a change to performing all cataract surgery under retrobulbar anaesthesia and the next 453 cases had no incidence of endophthalmitis.


CONCLUSIONS
Topical anaesthesia techniques in temporal clear corneal cataract extraction may be a factor in endophthalmitis.
Ellis
Mark F
MF
Hawthorn Eye Clinic, Melbourne, Victoria, Australia. mellis@connexus.net.au
D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000009:adverse effects*; D009877:Endophthalmitis / Q000209:etiology*; D015818:Eye Infections, Bacterial / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D018918:Phacoemulsification; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000209:etiology; D013212:Staphylococcus epidermidis / Q000302:isolation & purification*; D013290:Streptococcal Infections / Q000209:etiology; D013291:Streptococcus / Q000302:isolation & purification*