Gentamicin-loaded sponges; multimodal rehabilitation; nocardial endophthalmitis; acute-onset endophthalmitis

AORN Journal,  Nov, 2005  by George Allen

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* type of cataract surgery,

* interval from surgery to symptoms,

* comorbid systemic illness,

* visual acuity,

* detailed biomicroscopic examination,

* microbiological survey,

* details of treatment, and

* final visual and anatomic outcomes.

Infection was labeled "early" if symptoms of pain and decreased visual acuity occurred within six weeks of surgery and "late" if symptoms occurred more than six weeks after surgery. The outcome was evaluated in terms of anatomic and functional success. Anatomic success was defined as preservation of the globe, attached retina, best-corrected visual acuity of light perception or better, and no signs of active inflammation after three months. Functional success was defined as attached retina, with best-corrected visual acuity of 20/140 or better. Common statistical techniques, including the Wilcoxon two-sample rank sum test and the Fisher exact test, were used to analyze the data.

Findings. From records of 304,944 cataract surgeries performed during the study period, the researchers identified 196 cases of postoperative endophthalmitis, including 24 cases of nocardial endophthalmitis. Visual outcome was poor in the majority of patients. Final visual acuity of being able to detect only hand motions or worse was found in 19 out of 24 patients (79%), and 11 of 24 patients (46%) had no light perception. Initial visual acuity was significantly associated with the final visual outcome (P = .0026). The majority of patients (ie, 23 of 24) had early onset, and wound infection was noted in 11 of 24 patients (46%). Clinical features included scleral abscess, cotton ball exudates on the iris, and hypopyon.

Clinical implications. The results of this study suggest that nocardial endophthalmitis after cataract surgery is an aggressive disease with poor visual prognosis and that early diagnosis and treatment with good visual acuity at presentation may be associated with better visual outcomes. Given the devastating consequences of endophthalmitis, especially nocardial endophthalmitis, after cataract surgery, perioperative nurses must make every effort to maintain asepsis during these procedures.

Acute-onset endophthalmitis after cataract surgery

American Journal of Ophthalmology June 2005

Endophthalmitis, intraocular inflammation of the vitreous and anterior chamber of the eye, is a rare but serious complication of intraocular surgery that may result in severe vision loss. The increasing use of temporal clear corneal incisions and suture-less surgery raises controversy regarding the possible increased risk of postoperative endophthalmitis after cataract surgery. The objectives of this retrospective, observational study were to report the incidence, clinical settings, and visual acuity outcomes of acute-onset endophthalmitis after cataract surgery. (4)

Acute-onset endophthalmitis was defined as clinically diagnosed endophthalmitis occurring within six weeks after cataract surgery. Researchers reviewed the clinical records of all patients who were clinically diagnosed with endophthalmitis within six weeks after undergoing cataract surgery at a university-affiliated hospital in Miami between January 2000 and November 2004. The same OR protocol was used before all cataract procedures. The protocol included a preoperative prep using povidone-iodine solution to prepare the lids, lashes, and conjunctiva. Cataract surgeries that were combined with other procedures, including pars plana vitrectomy, trabeculectomy, or penetrating keratoplasty, were excluded from the study. Patients with delayed-onset endophthalmitis (ie, infection diagnosed more than six weeks after surgery) also were excluded. Common statistical methods were used to analyze the data.