Incidence Of Postoperative Endophthalmitis Following Cataract Surgery With Intracameral Vancomycin Prophylaxis – An 11-Year Uk Study

This study is aimed to evaluate the incidence of acute onset postoperative endophthalmitis in elective cataract surgery with intracameral vancomycin prophylaxis, describe the demographics of affected patients, and identify common causative organisms and risk factors

The study was conducted at Norfolk and Norwich University Hospital NHS Foundation Trust, a large teaching hospital in the United Kingdom

This observational study evaluated postoperative endophthalmitis cases following elective cataract surgery with phacoemulsification and intraocular lens implantation using intracameral vancomycin prophylaxis in all consecutive cases performed between June 2011 and December 2022. A prediluted, single-dose formulation of vancomycin 1 mg/0.1 mL in a pre-filled syringe manufactured by a UK tertiary hospital pharmacy was utilised for this purpose in the study. All patients received povidone–iodine 5% drops into the conjunctival sac and on the cornea for 2-3 minutes before the surgery. Microsoft Excel was used to analyse the data and results

Out of the 46,427 procedures performed, 21 cases of postoperative endophthalmitis were identified resulting in a rate of 0.045% (1 in 2210 cases). The incidence was highest among the 40 - 49 age group (0.169%), followed by patients aged 90 - 99 (0.155%) over 11 years. The mean age was 77 (range 47 – 93) and 10 cases (48%) were female. Visual outcomes were favourable, with 28.5% achieving 6/6 or better and 71.4% achieving 6/9 or better vision at 3 months. Of the 21 cases, 52% were caused by gram-negative organisms, and Pseudomonas was the most commonly isolated organism (38%). Culture-negative cases (n=10; 48%) had better outcomes. No cases of haemorrhagic occlusive retinal vasculitis (HORV) were observed

The incidence of postoperative endophthalmitis with intracameral vancomycin prophylaxis was very low (0.045%, n=46,427), and comparable with the ESCRS Endophthalmitis study (0.06%, n=13,698) which utilised prophylactic intracameral cefuroxime. This study supports the use of intracameral vancomycin prophylaxis as an alternative to cefuroxime in routine phacoemulsification, especially in patients with penicillin allergy. The use of prefilled syringes with pre-diluted single dose formulations may potentially reduce the risk of HORV. Ophthalmologists would find this study useful when considering the use of intracameral vancomycin prophylaxis in cataract surgery