From the Guidelines
The incidence of infectious ophthalmitis after cataract surgery is approximately 2 to 3 per 1000 cases in the absence of antibiotic prophylaxis. This condition, also known as endophthalmitis, can lead to severe consequences, including loss of the eye 1. The risk of postoperative endophthalmitis is a significant concern in cataract surgery, with around 800,000 patients undergoing this procedure annually in France alone 1.
Key factors that contribute to the development of infectious ophthalmitis after cataract surgery include:
- Advanced age
- Diabetes
- Immunocompromised state
- Presence of blepharitis or active ocular surface disease
- Intraoperative complications, such as posterior capsule rupture
To minimize the risk of infectious ophthalmitis, prophylactic measures such as intracameral injection of 1 mg of cefuroxime after surgery are commonly used 1. In cases where the patient is allergic to cefuroxime, alternative antibiotic prophylaxis strategies are employed, taking into account the specific risk factors associated with the surgery 1.
Prompt diagnosis and treatment with intravitreal antibiotics are crucial in managing infectious ophthalmitis and preserving vision 1. The most common causative organisms include coagulase-negative staphylococci, such as Staphylococcus epidermidis, although more virulent organisms like Streptococcus species and gram-negative bacteria can cause more severe presentations with worse visual outcomes 1.
From the Research
Incidence of Infectious Ophthalmitis after Cataract Surgery
- The incidence of endophthalmitis after cataract surgery has been studied in several research papers, with varying results 2, 3, 4, 5, 6.
- A study published in 2006 found that acute endophthalmitis can develop after cataract surgery despite the prophylactic use of fourth-generation fluoroquinolone antibiotics, with a positive bacterial culture rate of 45% 2.
- Another study published in 2021 discussed the use of intracameral antibiotics for endophthalmitis prophylaxis, highlighting the decreased endophthalmitis rates with routine antibiotic use, but also noting the variability in practice and the need for further research 3.
- A retrospective study published in 2025 found that the incidence of endophthalmitis after cataract surgery decreased significantly over a 23-year period, particularly after the introduction of intracameral cefuroxime, with a final incidence rate of 0.007% 4.
- Comparative studies have also been conducted to evaluate the effectiveness of different antibiotics, such as gatifloxacin and moxifloxacin, in reducing the risk of endophthalmitis after cataract surgery 5.
Risk Factors and Prevention
- The use of povidone-iodine before surgery combined with intracameral cefuroxime has been shown to drastically reduce the incidence of endophthalmitis 4.
- Intracameral injection of antibiotics, such as cefuroxime, moxifloxacin, and vancomycin, has been found to be effective in preventing postoperative endophthalmitis, but the practice has not been universally adopted 3, 6.
- The choice of antibiotic and the decision to use intracameral prophylaxis vary depending on factors such as antibiotic availability, cost, and the spectrum of causative organisms 3.
Epidemiology
- The incidence rate of endophthalmitis has been found to decline after 2007, with a simultaneous increase in the use of intracameral injection of antibiotics at the conclusion of cataract surgery 6.
- The most common flora isolated in cases of endophthalmitis include coagulase-negative Staphylococcus, Staphylococcus aureus, and Corynebacterium diphtheria 5.