Efficacy and cost-effectiveness of intracameral vancomycin in reducing postoperative endophthalmitis incidence in Australia.
BACKGROUND
Endophthalmitis is a rare but devastating postoperative complication of cataract surgery. We aimed to describe the incidence of acute postoperative endophthalmitis in an Australian population over a 14-year period.


METHODS
This was a retrospective longitudinal cohort study performed at Westmead Hospital, a major tertiary hospital in Sydney, Australia.


METHODS
Patients who had acute postoperative endophthalmitis within 6 weeks of their cataract surgery at Westmead Hospital were included.


METHODS
Endophthalmitis cases from 2000 to 2014 were identified from computerized diagnostic coding. These were cross-referenced with the cataract surgery list over this time period. The routine use of intracameral vancomycin at the end of cataract surgery was introduced in Westmead Hospital in 2004.


METHODS
We quantified the incidence of acute postoperative endophthalmitis pre and post the routine use of intracameral vancomycin.


RESULTS
A total of 14 805 cataract cases were performed at Westmead Hospital from 2000 to 2014. Seventeen cases of endophthalmitis were within 6 weeks post cataract surgery performed at Westmead Hospital. In the period 2000 to 2003, the incidence of postoperative endophthalmitis was 0.43% (11/2539). From 2004 to 2014, there was a dramatic decrease in the incidence of postoperative endophthalmitis to 0.049% (6/12 266, P < 0.0001).


CONCLUSIONS
There has been a nine-fold reduction in the rate of acute postoperative endophthalmitis with the use of intracameral vancomycin in cataract surgery. Post-cataract surgery endophthalmitis is now a relatively rare cause of endophthalmitis in this Australian population. Our study supports the routine use of intracameral vancomycin as postoperative endophthalmitis prophylaxis.
Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia.
Cheryl Py
CP
Au
Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia.|Centre for Vision Research, Westmead Millennium Institute, University of Sydney, Sydney, New South Wales, Australia.
Andrew Jr
AJ
White
Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia.|Centre for Vision Research, Westmead Millennium Institute, University of Sydney, Sydney, New South Wales, Australia.
Paul R
PR
Healey
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000187:drug effects; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001315:Australia; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D009877:Endophthalmitis / Q000191:economics / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D015818:Eye Infections, Bacterial / Q000191:economics / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014640:Vancomycin / Q000191:economics* / Q000627:therapeutic use*; D014792:Visual Acuity / Q000502:physiology
D000900:Anti-Bacterial Agents; D014640:Vancomycin
antibiotics; cataract surgery; endophthalmitis; infectious endophthalmitis