The epidemiology of acute endophthalmitis after cataract surgery in an Asian population.
OBJECTIVE
To describe the incidence, risk factors, and clinical outcome of acute endophthalmitis after cataract extraction in a multiethnic Asian population.


METHODS
Prospective case series.


METHODS
All patients with cataract extractions performed at the Singapore National Eye Center from 1996 to 2001.


METHODS
Data on patients with acute endophthalmitis cases presenting within 6 weeks after cataract surgery were prospectively collected in a standardized format.


METHODS
Acute endophthalmitis after cataract surgery.


RESULTS
During the study period, 44 803 cataract operations (25 476 phacoemulsification and 19 327 extracapsular cataract extractions) were performed. There were 34 cases of acute endophthalmitis (average annual incidence of 0.076%), 21 of which were culture positive (average annual incidence of 0.040%). In multivariate analysis, risk of endophthalmitis was associated with phacoemulsification technique (relative risk [RR], 1.9; 95% confidence interval [CI], 0.9, 3.9; P = 0.10 for all endophthalmitis cases; RR, 3.1; 95% CI, 1.1, 9.4; P = 0.04 for culture-positive endophthalmitis cases) and the occurrence of intraoperative posterior capsule rupture (RR, 8.0; 95% CI, 3.1, 20.7; P<0.001 for all endophthalmitis cases; RR, 11.0; 95% CI, 3.7, 23.9; P<0.001 for culture-positive endophthalmitis cases). After a median follow-up of 234 days, half of the eyes achieved a final best-corrected visual acuity of 20/40. Predictors of this visual acuity included baseline acuity of counting fingers or better, culture-negative endophthalmitis, or infection caused by coagulase-negative Staphylococcus.


CONCLUSIONS
The incidence of acute endophthalmitis after cataract extraction in Singapore is consistent with rates reported elsewhere. The phacoemulsification technique is associated with a higher risk of acute culture-positive endophthalmitis compared with extracapsular cataract extraction. Intraoperative posterior capsule rupture is associated with an 8- to 11-fold higher risk of acute endophthalmitis, suggesting that these eyes should be closely monitored for signs of infection in the immediate postoperative period.
Wong
Tien Yin
TY
Singapore National Eye Center and Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore 168751, Republic of Singapore.
Chee
Soon-Phaik
SP
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D044466:Asian People / Q000706:statistics & numerical data*; D002387:Cataract Extraction / Q000379:methods / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D009877:Endophthalmitis / Q000208:ethnology* / Q000382:microbiology / Q000628:therapy; D015818:Eye Infections, Bacterial / Q000208:ethnology* / Q000382:microbiology / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy
D000900:Anti-Bacterial Agents