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The epidemiology of acute endophthalmitis after cataract surgery in a Mexican hospital for a period of five years: incidence and outcome

Poster Details

First Author: J.Villalobos-Ojeda MEXICO

Co Author(s):    S. Peniche   V. Vanzinni           

Abstract Details



Purpose:

To investigate the epidemiology of postoperative endophthalmitis after cataract surgery in a mexican hospital for a period of five years.

Setting:

Mexican Hospital School

Methods:

Retrospective , observational case series. The clinical and microbiological records of all patients with a clinical diagnosis of endophthalmitis within 6 weeks after cataract surgery, regardless of the technique (phacoemulsification or extracapsular extraction) in a period between January 2005 and April 2011 were reviewed. Main outcome measures: Incidence, surgical technique, intraoperative complications, treatment, microorganisms found and final visual acuity.

Results:

The incidence of postoperative endophthalmitis was 0.06% (15/24601) (95% CI 0.0030 -0.0028) for cataract surgery by any method, 0.04% by phacoemulsification, and 0.16% by extracapsular extraction. Eight of the fifteen (53.33%) patients had complications; seven posterior capsule rupture requiring anterior vitrectomy and one zonular dialysis with placement of capsular tension ring. Fifteen patients received intravitreal and topical vancomycin, ceftazidime and dexamethasone, six (40%) underwent posterior vitrectomy. The microorganisms isolated from aqueous humor and vitreous humor were mostly Gram-positive. The resistance to commonly used antibiotics was 31.20% to vancomycin, 30% to ceftazidime, 15.30% to moxifloxacin, and 7.40% to gatifloxacin. After a median follow-up of 120 days, best-corrected visual acuity in the affected eye was less than 1.00logmar in 10 (62.5%) and more than 0.4logmar in 3 (20%). A predictor of final visual acuity better than 0.4 was baseline acuity of counting fingers or better (OR 0.05)

Conclusions:

Endophthalmitis is a devastating complication , particularly when it occurs after any intraocular surgery, 10 million cataract surgeries are performed each year , with 26,500 cases of endophthalmitis , giving an incidence of 0.06 % - 0.32 % 1.2 The incidence in our hospital is 0.04% as reported in the literature . Organisms causing postoperative endophthalmitis are gram positive 90-98 % . The treatment given to our patients is reported in the literature , it is important to consider the resistance found in our study to the most commonly used antibiotics ( vancomycin plus ceftazidime ) , and that sometimes it is necessary to consider the use of a different antibiotic, That´s why is so important to take samples of aqueous humor and vitreous humor . The potential risk factors described above are intra operative complications that prolong surgical time , immunosuppression, silicone intraocular lenses and no self-sealing incisions that occurred in our patients by up to 53.33 % FINANCIAL INTEREST: NONE

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