title: The Incidence of Postoperative Endophthalmitis Before and After a Revised Preoperative Surgical Site Preparation Protocol.
abstract: OBJECTIVE
  To compare the incidence of postoperative endophthalmitis before and after the implementation of a preoperative surgical site preparation protocol for cataract surgery.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Records of patients with postoperative endophthalmitis between January 2006 and August 2013 were reviewed. A revised protocol implemented after January 2009 included the addition of preoperative 0.3% topical tobramycin, 10% povidone-iodine for cleansing, and using a disposable sterile drape. The incidence, microbiological profile, and outcomes of these cases were analyzed.
  
  
  RESULTS
  The incidence of preprotocol endophthalmitis was significantly higher than in the postprotocol period (P = 0.018). More patients in the preprotocol group grew Pseudomonas aeruginosa and Streptococcus pneumoniae as compared with those in the postprotocol group (P = 0.014). A smaller number of patients attained a poor visual outcome after the implementation of the revised protocol (P = 0.035).
  
  
  CONCLUSIONS
  In our study, the addition of antibiotic eye drops before cataract surgery and perioperative cleansing with 10% povidone-iodine were effective means to reduce the incidence of postoperative endophthalmitis.
authors.affiliation: From the *Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong; †Prince of Wales Hospital; and ‡Alice Ho Miu Ling Nethersole Hospital, Shatin, Hong Kong.
authors.forename: Rachel P W
authors.initials: RP
authors.lastname: Kwok
authors.forename: Wilson W K
authors.initials: WW
authors.lastname: Yip
authors.forename: Vishal
authors.initials: V
authors.lastname: Jhanji
authors.forename: Vesta C K
authors.initials: VC
authors.lastname: Chan
authors.forename: Alvin L
authors.initials: AL
authors.lastname: Young
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D002387:Cataract Extraction / Q000009:adverse effects*; D002985:Clinical Protocols; D009877:Endophthalmitis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015818:Eye Infections, Bacterial / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000008:administration & dosage; D011183:Postoperative Complications / Q000517:prevention & control*; D011206:Povidone-Iodine / Q000627:therapeutic use; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D014031:Tobramycin / Q000008:administration & dosage; D014792:Visual Acuity
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D009883:Ophthalmic Solutions; D011206:Povidone-Iodine; D014031:Tobramycin