Topical anesthesia: possible risk factor for endophthalmitis after cataract extraction.
OBJECTIVE
To assess the relationship between the risk for acute endophthalmitis after cataract extraction and whether certain factors, such as surgeon qualification, numerical order, duration of surgery, operating theater, and type of anesthesia (topical or retrobulbar), could be modified to decrease the risk.


METHODS
Single-center academic practice.


METHODS
Two epidemiological studies were performed: a case-control study and a retrospective cohort study. The surgical records of all patients with clinically diagnosed endophthalmitis within 30 days after cataract surgery performed between February 2002 and September 2003 were reviewed. The endophthalmitis cases were compared with 108 randomly selected controls (4 controls per case). The global incidence of endophthalmitis and the incidence according to type of anesthesia were calculated.


RESULTS
Of 5011 cataract extractions performed, 27 cases of endophthalmitis occurred. The incidence was 5.39 per 1000 procedures. An independent statistically significant relationship was found between endophthalmitis and the use of topical anesthesia (odds ratio [OR], 11.8; 95% confidence interval [CI], 2.4-58.7) and surgery longer than 45 minutes (OR, 7.2; 95% CI, 1.7-29.7) but not between the other variables. The incidence of endophthalmitis was 1.8 per 1000 cataract extractions with retrobulbar anesthesia and 6.76 per 1000 with topical anesthesia (relative risk [RR], 3.76; 95% CI, 0.89-15.85). After the start of the study period was extended to May 2001, the incidence of endophthalmitis was 1.3 per 1000 cataract extractions with retrobulbar anesthesia and 8.7 per 1000 with topical anesthesia (RR, 6.72; 95% CI, 1.63-27.63).


CONCLUSIONS
Results suggest that there may be an association between topical anesthesia and endophthalmitis after cataract extraction.
Garcia-Arumi
Jose
J
Department of Ophthalmology, Hospital Valle d'Hebrón, Universidad Autónoma de Barcelona, Paseo Valle de Hebrón 119-129, 08035 Barcelona, Spain.
Fonollosa
Alex
A
Sararols
Laura
L
Fina
Francesc
F
Martínez-Castillo
Vicente
V
Boixadera
Ana
A
Zapata
Miguel A
MA
Campins
Magda
M
D000208:Acute Disease; D000772:Anesthesia, Local; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D009877:Endophthalmitis / Q000453:epidemiology* / Q000517:prevention & control; D015818:Eye Infections, Bacterial / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D019654:Lens Implantation, Intraocular; D016017:Odds Ratio; D018918:Phacoemulsification; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
D000900:Anti-Bacterial Agents