Incidence And Management Of Corneal Wound Infection Following Cataract Surgery

Corneal wound infection is a serious complication following cataract surgery as it can cause rapid irreversible visual loss. The incidence of corneal wound infections has not yet been reported.

Newmedica, Northampton Eye Health Clinic & Surgical Centre.

A total of eleven thousand six hundred consecutive cases of cataract surgery were assessed or reported for corneal wound infection from 25/7/22 to 28/2/26. Assessment occurred at the 4–6-week follow-up appointment or during an acute post-operative presentation. Cases of corneal abrasion were excluded.  Each case was performed through a clear corneal 2.2mm incision under topical anaesthesia. Two incisions were temporal and one was superior. Post operative drops were Ketorolac 0.4% ( Allergan) three times a day and Dexamethasone 0.1% (Alcon) four times a day both for 3 weeks.

Corneal wound infection occurred in three patients (incidence 0.026%); two presented acutely to our department, one to another eye unit. Post-operative presentations were 8, 21 and 22 days. Pseudomonas aeruginosa caused all three cases; each patient was admitted to hospital for intensive topical antibiotic drops until the infection resolved. No wound leak was present in any case. One patient developed endophthalmitis consequently with no light perception; two patients recovered their vision.

Patients were aged 81, 92, 93. Surgery was uneventful except one had a brunescent cataract and another required intracameral phenylephrine for a medium sized pupil. One patient had type two diabetes. Two patients lived alone and had carers.

Corneal wound infection risks significant visual impairment, including endophthalmitis. This is the first publication reporting its incidence. The low rate of incidence is surprising because the wound epithelium is often compromised from repeated surgical entries, hydration, post-operative steroid and NSAID drops which impair healing. Unlike the more commonly reported organisms staphylococcus and streptococcus, our cases were pseudomonas which is associated with a more aggressive infection.

Older age and social vulnerability likely contributed to delayed presentation and adverse outcomes, highlighting the importance of educating patients and carers on recognising and reporting acute symptoms promptly to avoid delay in treatment.