What are the early post-operative complications of endophthalmitis following cataract surgery?

From the Guidelines

Endophthalmitis following cataract surgery is a medical emergency that requires immediate recognition and treatment to prevent severe vision loss and potential blindness, and the most effective prevention strategy includes proper preoperative preparation with povidone-iodine, careful sterile technique, and prophylactic antibiotics, with intracameral antibiotic administration being the most effective method to reduce the risk of postoperative bacterial endophthalmitis, as supported by recent evidence 1. The standard treatment for endophthalmitis includes intravitreal vancomycin (1.0 mg/0.1 mL) and ceftazidime (2.25 mg/0.1 mL), often supplemented with topical fortified antibiotics such as vancomycin and tobramycin drops every hour. Some key points to consider in the management of endophthalmitis include:

• Immediate referral to an ophthalmologist for vitreous tap and intravitreal antibiotic injection if endophthalmitis is suspected based on symptoms like severe eye pain, decreased vision, redness, lid swelling, and hypopyon (pus in the anterior chamber)
• Systemic antibiotics may be added in severe cases
• Vitrectomy surgery is indicated for severe presentations with light perception vision or worse
• Prevention strategies include proper preoperative preparation with povidone-iodine, careful sterile technique, and prophylactic antibiotics
• Addressing moderate to severe blepharitis with topical antibiotics and eyelid hygiene prior to intraocular surgical procedure may also be helpful in reducing the risk of endophthalmitis, as blepharitis is a risk factor in the development of endophthalmitis after intravitreal injection and in bleb-related infection 1. It is essential to note that the infection occurs when bacteria, most commonly coagulase-negative Staphylococci, enter the eye during or after surgery, triggering severe inflammation that can permanently damage retinal structures if not promptly treated.

From the Research

Cataract Surgery Early Post-Op Complication of Endophthalmitis

• Endophthalmitis is a serious complication following cataract surgery, often inducing a substantial reduction of visual acuity 2.
• The incidence of endophthalmitis has declined due to various preoperative and perioperative measures, including the use of antiseptic and appropriate surgical draping techniques 3.
• Commonly used intracameral antibiotics for endophthalmitis prophylaxis include cefuroxime, moxifloxacin, and vancomycin, with routine cefuroxime use becoming common in many European countries 4.
• Risk factors for the development of endophthalmitis following cataract surgery include patient age, intraoperative surgical complications, and poor wound construction 5.
• The optimal antibacterial strategy for the prevention of endophthalmitis should be safe, inexpensive, and broad in microbiological activity spectrum, while not requiring patient compliance for its effectiveness 5.

Treatment and Management

• Aggressive initial treatment, including IOL removal, may be associated with a lower frequency of recurrent disease 2.
• Early diagnosis followed by management of patients either with vitreous tap or vitrectomy coupled with intravitreal antibiotics holds the key to preventing vision loss 3.
• Intracameral antibiotics, such as cefuroxime, moxifloxacin, and vancomycin, have been shown to decrease the incidence of postoperative endophthalmitis, but the decision to use them varies considerably throughout the world due to antibiotic availability and cost 4, 6.

Prevention

• Aseptic technique with pre-operative instillation of povidone-iodine remains the only technique supported by level I evidence to reduce the incidence of endophthalmitis 6.
• The routine use of intracameral antibiotics continues to increase throughout the world, but data from multicenter, randomized, prospective trials is needed to provide better guidance regarding the prophylactic use of antibiotics 6.