ESCRS - FP21.01 - Evolution Of Endophthalmitis Rate After Cataract Surgery Over The Last 23 Years: A Large Single-Center Study.

Evolution Of Endophthalmitis Rate After Cataract Surgery Over The Last 23 Years: A Large Single-Center Study.

Published 2023 - 41st Congress of the ESCRS

Reference: FP21.01 | Type: Free paper | DOI: 10.82333/1t2t-1z96

Authors: Alexandre Hage* 1 , Paul Bastelica 1 , Alexandre Majoulet 1 , Marion Laurent 1 , Lilia Merabet 2 , Françoise Brignole-Baudouin 3 , Antoine Labbé 4 , Christophe Baudouin 5

1Ophthalmology - Pr Christophe Baudouin,Quinze-Vingts National Ophthalmology Hospital,Paris,France, 2Ophthalmo-biology Laboratory,Quinze-Vingts National Ophthalmology Hospital,Paris,France, 3Ophthalmo-biology Laboratory,Quinze-Vingts National Ophthalmology Hospital,Paris,France;Sorbonne Université, INSERM, CNRS, Institut de la Vision, IHU FOReSIGHT,Paris,France, 4Ophthalmology - Pr Christophe Baudouin,Quinze-Vingts National Ophthalmology Hospital,Paris,France;Ophthalmology,Ambroise-Paré Hospital,Boulogne-Billancourt,France;Sorbonne Université, INSERM, CNRS, Institut de la Vision, IHU FOReSIGHT,Paris,France, 5Ophthalmology - Pr Christophe Baudouin,Quinze-Vingts National Ophthalmology Hospital,Paris,France;Sorbonne Université, INSERM, CNRS, Institut de la Vision, IHU FOReSIGHT,Paris,France

Purpose

The aim of this study is to describe the evolution of endophthalmitis rates after cataract surgery during the last two decades in a large tertiary ophthalmology center

Setting

Cataract surgery is the most performed surgery in the world. Acute Postoperative Endophthalmitis (APE) is a rare but severe complication of this surgery. During the last decades, the use of povidone-iodine (PVI) before surgery, associated with intracameral cefuroxime at the end of surgery drastically reduced the incidence of endophthalmitis. Some reports have however associated 2% lidocaine gel to increased APE.

Methods

A single-center retrospective descriptive study was conducted in the Quinze-Vingts National Ophthalmology Hospital (Paris, France). We retrospectively included all eyes that underwent cataract surgery between 2000 and 2022. Cases of APE following cataract surgery were reported. The main outcome was the evolution of the yearly incidence of APE after cataract surgery. Rates were compared before and after the following events: introduction of 2% lidocaine gel, application of a prophylactic protocol for local anesthesia, use of intracameral cefuroxime at the end of surgery and systematic use of 2% lidocaine gel.

Results

We included 178,752 cataract procedures in the study. A total of 49 APE were reported and confirmed microbiologically between 2000 and 2022 (0.027%). Endophthalmitis rates progressively decreased between 2000 and 2022, particularly after the introduction of intracameral cefuroxime in surgical practice in 2011 (0.064% before vs 0.007% after cefuroxime protocol). Since an adequate protocol for topical anesthesia was adopted in 2007, and intracameral cefuroxime was used systematically, rates of APE decreased and remained as low as 0.007% for the last decade, even though the number of yearly cataract procedures almost doubled. Endophthalmitis incidence did not increase after systematic use of 2% lidocaine gel use before surgery.

Conclusions

Endophthalmitis incidence after cataract surgery significantly decreased over the last twenty-three years in our tertiary care center. The use of PVI before surgery along with systematic intracameral cefuroxime at the end of the procedure allowed to reach very low endophthalmitis rates (0.007%). Contrarily to previous reports and similarly to large studies on intravitreal injections, the use of 2% lidocaine gel in our center over the last decade did not increase endophthalmitis rates, when applied after PVI and associated with intracameral cefuroxime. It can therefore be safely used as a topical anesthetic in standard cataract surgery protocols.