Harry W. Flynn, Jr., MD (Miami, FL), John J. Miller, MD (Miami, FL), William E. Smiddy, MD (Miami, FL), Darlene Miller, MPH (Miami, FL)

PURPOSE:

To report the incidence, clinical settings and visual acuity outcomes of acute-onset endophthalmitis following cataract surgery.

METHODS:

In this retrospective, observational case series, annual cataract surgery statistics were determined by review of electronic surgical records. The clinical and microbiological records were reviewed of all patients with clinically diagnosed endophthalmitis within 6 weeks following cataract surgery at a single universityaffiliated hospital between January 2000 and
December 2005. Both culture positive and culture negative cases were included.

RESULTS:

The incidence of acute-onset endophthalmitis following cataract surgery was 0.04% (8/19,633) for cataract surgeries of all methods, 0.05% (7/14,729) for cataract surgery by clear cornea phacoemulsification and 0.02% (1/4,904) for cataract surgery by methods other than clear corneal phacoemulsification. Four of 8 (50%) patients had an intraoperative complication: vitreous loss in3 patients and iris prolapse in one patient. Two patients had culture negative endophthalmitis. Of the 6 culture positive cases, five were due to coagulase negative staphylococcus and one was due to Streptococcus pneumoniae. In the culture
positive isolates, three were sensitive to fluoroquinolones and two were resistant. Initial management included vitrectomy in 3 patients, but all patients received intravitreal antibiotics. The visual acuity at final follow-up was 20/40 or better in 5 patients and count fingers or worse in 3 patients.

CONCLUSION:

The incidence of acute-onset endophthalmitis after temporal clear cornea incision phacoemulsification is low (0.05%). In spite of periocular treatment with fluoroquinolones, endophthalmitis continues to occur.