Retrospective Analysis Of Post-Operative Endophthalmitis Following Cataract Surgery: A 6-Year Review Of ~30,000 Procedures Emphasizing Mrsa Absence And Prophylactic Strategies In A Tertiary Center

To evaluate the incidence, microbiological profile, and outcomes of endophthalmitis following cataract surgery at a tertiary ophthalmology department over a 6-year period (2019-2024), based on a large database of approximately 30,000 procedures, with a specific focus on the absence of methicillin-resistant Staphylococcus aureus (MRSA)-related infections and the effectiveness of preventive screening protocols.

Department of Ophthalmology and Optometry, Klinikum Klagenfurt, tertiary referral center, Austria; high-volume cataract surgery practice (~30,000 in-house procedures, 2019-2024).

Retrospective review of hospital archives, operation records, and microbiology data from Klinikum Klagenfurt, Austria. Total cataract surgeries performed in-house were approximately 30,000. We identified 29 eyes treated with intravitreal antibiotics (vancomycin 0.1 mL and ceftazidime 0.1 mL, with or without corticosteroids) for suspected or confirmed post-cataract endophthalmitis; cases included both in-house ("in domo", n=15) and referred ("ex domo", n=14) procedures. Microbiological findings, visual acuity outcomes, and demographics were analyzed. Additionally, 15 patients with MRSA-positive swabs (27 total swabs) were reviewed for infection outcomes following precautionary measures, primarily before cataract procedures.

Among ~30,000 cataract surgeries, 29 endophthalmitis cases occurred, with no MRSA detected; common isolates included Staphylococcus epidermidis (n=3) and Cutibacterium acnes (n=2), with 65.5% showing no growth. Median admission visual acuity (VA) was 0.02 (hand motions), improving to 0.25 at discharge. No cases of MRSA endophthalmitis occurred across the entire cohort, including MRSA-colonized patients who underwent procedures after targeted preventive measures (last-case scheduling and preoperative rifampicin 600 mg).

This study demonstrates a low incidence of culture-positive endophthalmitis post-cataract surgery in a high-volume tertiary center, with zero MRSA cases despite screening positives and ~30,000 procedures performed. Preventive strategies for MRSA carriers appear highly effective, offering a scalable model for global institutions to minimize infection risks in cataract surgery.