Epidemiological evaluation of intraoperative antibiosis as a protective agent against endophthalmitis after cataract surgery.
OBJECTIVE
To evaluate risk factors for endophthalmitis after cataract surgery and to retest recent findings on the protective effect of intraoperative antibiosis and the promoting effect of the clear corneal as compared to sclerocorneal incision.


METHODS
Survey study.


METHODS
Five hundred thirty-eight ophthalmosurgical centers in Germany.


METHODS
Responder specific endophthalmitis incidence.


RESULTS
A total of 310 (58%) questionnaires were computed resulting in an overall count of 404 356 cataract surgeries and 291 self-reported endophthalmitis cases (crude rate 0.072%). The risk of postoperative endophthalmitis for sclerocorneal versus clear corneal incisions was not significantly reduced (relative risk 0.97, 99% confidence interval 0.69-1.38). The hypothesis of a protective effect of intraocular antibiosis could be confirmed by a significantly decreased risk ratio of 0.69 (99% confidence interval 0.48-0.99) indicating a significant benefit from intraoperative intraocular antibiosis. A similar tendency was observed for an intraoperative periocular antibiosis with a significantly reduced risk ratio of 0.68 (99% confidence interval 0.49-0.96). These risk estimates had been adjusted for the size of the surgical center: a significantly reduced risk ratio of 0.70 (99% confidence interval 0.49-0.98) for postoperative endophthalmitis was observed for local centers.


CONCLUSIONS
Whereas this 2001 appraisal of a survey in 1996 could not reproduce the benefit of sclerocorneal incision, the protective effect of intraoperative intraocular antibiotic prophylaxis could be confirmed. However, the results of this survey have to be interpreted with care, since it is not based on individual case information, but rather on aggregate questionnaire data.
Krummenauer
Frank
F
Clinical Epidemiology and Health Economy Unit Dresden University of Technology, Germany. Frank.Krummenauer@uniklinikum-dresden.de
Kurz
Sabine
S
Dick
H Burkhard
HB
D019072:Antibiotic Prophylaxis / Q000379:methods*; D002387:Cataract Extraction / Q000009:adverse effects* / Q000379:methods; D009877:Endophthalmitis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D005858:Germany; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors