Nosocomial acute-onset postoperative endophthalmitis at a university teaching hospital in China

Summary

A retrospective study of all intra-ocular operations performed at Zhongshan Ophthalmic Centre, China between 1 January 2000 and 30 December 2009 was conducted to gain further knowledge about nosocomial acute-onset postoperative endophthalmitis. In total, 147,244 intra-ocular operations were performed during this period. Acute-onset postoperative endophthalmitis was diagnosed in 29 cases, giving a frequency of 0.020%. The frequency remained low and did not increase over the 10-year period. The highest rate of endophthalmitis was found following secondary intra-ocular lens implantation (0.129%). Cataract surgery had a rate of 0.01%, which is on the lower end of estimates from other large-scale studies. Gram-positive bacteria were the most commonly isolated organisms (71%), with the majority being Staphylococcus epidermidis (64%). However, no S. epidermidis was identified in the cases following cataract extraction; these patients received intracameral vancomycin at the end of the procedure. Visual outcomes of patients with postoperative endophthalmitis were generally poor. Three (10%) patients had visual acuity (VA) ≥20/40 at the final follow-up visit (all had undergone cataract surgery) and 15 (52%) patients had VA ≤20/400 at the final follow-up visit (10 had undergone pars plana vitrectomy). Factors associated with poor visual outcomes included initial VA of hand motions or worse, and positive culture results. The results of this 10-year study may serve as a source of comparison for other centres and future studies.

Introduction

Postoperative endophthalmitis is an uncommon but devastating complication of intra-ocular surgery, often resulting in blindness. Factors affecting the incidence of postoperative endophthalmitis include type of surgery, aseptic techniques and choice of antibiotics. Previous studies have shown that the overall incidence of postoperative endophthalmitis has declined dramatically in the past century, from approximately 10% in the late 1800s to 0.58% in the mid-1900s to 0.09% in the early 1990s to 0.05% in 1995–2001.1, 2, 3, 4 A recent study demonstrated that the rate has declined to 0.03%.⁵ However, most of these investigations were performed in Western countries, and few data are available for Asian countries. As such, the aim of this study was to evaluate the incidence, predisposing surgery, clinical course, organisms isolated and final outcome of postoperative endophthalmitis at a university teaching hospital in China.