title: Incidence of postoperative endophthalmitis from 1990 to 2009 using povidone-iodine but no intracameral antibiotics at a single academic institution.
abstract: OBJECTIVE
  To correlate the incidence of postoperative endophthalmitis with changes in the preoperative prophylaxis over a 20-year period.
  
  
  METHODS
  Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Patients diagnosed with postoperative endophthalmitis from 1990 to 2009 after intraocular surgery performed at the same institution were included. Because of changes in the preoperative prophylaxis during the study period, 3 groups were formed for data analysis: Period 1 (1990 to 1992), no standardized prophylaxis regimen; period 2 (1993 to 1998), preoperative topical medication, povidone-iodine 10.0% periorbitally, and 1 drop of povidone-iodine 1.0% in the conjunctiva sac; and period 3 (1999 to 2009), similar to period 2 except with irrigation of the conjunctival sac with 10 mL of povidone-iodine 1.0%.
  
  
  RESULTS
  The overall rate of postoperative endophthalmitis was 0.113% (77/68,323) for all intraocular surgeries. It decreased significantly from 0.291% (16/5505) in period 1 to 0.170% (33/19,413) in period 2 to 0.065% (28/43,405) in period 3 (P < .001). In cataract surgery, the overall rate of postoperative endophthalmitis was 0.125% (30/24,034). It decreased in each subsequent period, from 0.338% (9/2662) in period 1 to 0.224% (15/6696) in period 2 to 0.041% (6/14,676) in period 3 (P < .001). Coagulase-negative Staphylococcus was the most commonly isolated organism (47.4%).
  
  
  CONCLUSIONS
  The rate of postoperative endophthalmitis decreased over a 20-year period at a single academic institution. Although multiple factors might have contributed to this decline, implementation of a preoperative prophylaxis protocol using copious povidone-iodine might have been the most important contributor.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From the Department of Ophthalmology (Nentwich, Kreutzer, Li, Schwarzbach, Yactayo-Miranda, Kampik, Miño de Kaspar), Ludwig-Maximilians-University, Munich, Germany; the Department of Ophthalmology (Ta), School of Medicine, Stanford University, Stanford, California, USA. Electronic address: martin.nentwich@med.uni-muenchen.de.
authors.forename: Martin M
authors.initials: MM
authors.lastname: Nentwich
authors.affiliation: From the Department of Ophthalmology (Nentwich, Kreutzer, Li, Schwarzbach, Yactayo-Miranda, Kampik, Miño de Kaspar), Ludwig-Maximilians-University, Munich, Germany; the Department of Ophthalmology (Ta), School of Medicine, Stanford University, Stanford, California, USA.
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Ta
authors.affiliation: From the Department of Ophthalmology (Nentwich, Kreutzer, Li, Schwarzbach, Yactayo-Miranda, Kampik, Miño de Kaspar), Ludwig-Maximilians-University, Munich, Germany; the Department of Ophthalmology (Ta), School of Medicine, Stanford University, Stanford, California, USA.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Kreutzer
authors.affiliation: From the Department of Ophthalmology (Nentwich, Kreutzer, Li, Schwarzbach, Yactayo-Miranda, Kampik, Miño de Kaspar), Ludwig-Maximilians-University, Munich, Germany; the Department of Ophthalmology (Ta), School of Medicine, Stanford University, Stanford, California, USA.
authors.forename: Bing
authors.initials: B
authors.lastname: Li
authors.affiliation: From the Department of Ophthalmology (Nentwich, Kreutzer, Li, Schwarzbach, Yactayo-Miranda, Kampik, Miño de Kaspar), Ludwig-Maximilians-University, Munich, Germany; the Department of Ophthalmology (Ta), School of Medicine, Stanford University, Stanford, California, USA.
authors.forename: Fabian
authors.initials: F
authors.lastname: Schwarzbach
authors.affiliation: From the Department of Ophthalmology (Nentwich, Kreutzer, Li, Schwarzbach, Yactayo-Miranda, Kampik, Miño de Kaspar), Ludwig-Maximilians-University, Munich, Germany; the Department of Ophthalmology (Ta), School of Medicine, Stanford University, Stanford, California, USA.
authors.forename: Yazmin M
authors.initials: YM
authors.lastname: Yactayo-Miranda
authors.affiliation: From the Department of Ophthalmology (Nentwich, Kreutzer, Li, Schwarzbach, Yactayo-Miranda, Kampik, Miño de Kaspar), Ludwig-Maximilians-University, Munich, Germany; the Department of Ophthalmology (Ta), School of Medicine, Stanford University, Stanford, California, USA.
authors.forename: Anselm
authors.initials: A
authors.lastname: Kampik
authors.affiliation: From the Department of Ophthalmology (Nentwich, Kreutzer, Li, Schwarzbach, Yactayo-Miranda, Kampik, Miño de Kaspar), Ludwig-Maximilians-University, Munich, Germany; the Department of Ophthalmology (Ta), School of Medicine, Stanford University, Stanford, California, USA.
authors.forename: Herminia
authors.initials: H
authors.lastname: Miño de Kaspar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000187:drug effects; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D001419:Bacteria / Q000302:isolation & purification; D002387:Cataract Extraction; D002648:Child; D002675:Child, Preschool; D009877:Endophthalmitis / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D015817:Eye Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011206:Povidone-Iodine / Q000008:administration & dosage*; D065129:Pre-Exposure Prophylaxis; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine