CATARACT & REFRACTIVE
Endophthalmitis after surgery Lower endophthalmitis risk in bilateral same-day cataract surgery. Dermot McGrath reports
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ilateral same-day cataract surgery is associated with a lower endophthalmitis rate than that of unilateral surgery, according to analysis of more than 1.4 million operations in the Swedish National Cataract Registry. “We all know that bilateral cataract surgery may have distinct advantages and I think it would be used much more if we did not have the fear of causing bilateral complications, of which endophthalmitis is the most feared,” Per Montan MD told delegates attending the European Society of Ophthalmology meeting in Nice, France. Dr Montan’s study looked at various risk factors for endophthalmitis using a logistic regression model to analyse data in the Swedish National Cataract Registry over a period from 2002 to 2017. “Some clear trends are evident. The number of surgeries has increased over the years, as has the use of bilateral cataract surgery. The age of the patients is decreasing and the visual acuity of the operated eye is also a lot higher than it used to be, with surgeons quicker to treat patients that are in the early stage of cataract development. Finally, we see that the capsular rupture rate is constantly decreasing among our operations, from 2.6% in 2002 to 1.2% in 2010 and 0.8% in 2017,” he said. As elsewhere in the developed world, the incidence of endophthalmitis has declined steadily over the years in Sweden. “This is mainly due to the decrease of risk factors that we have been analysing in our registry. Older age over the age of 85 seems to be a risk factor, as is the non-use of intracameral antibiotics and capsular rupture,” said Dr Montan, St Erik’s Eye Hospital, Stockholm, Sweden. Dr Montan said that over the 16-year period there were 14 cases of endophthalmitis in 92,200 bilateral surgeries, which is a rate of 0.015%, or one case in every 6,000 surgeries. This compared with 412 cases in 1,364,600 surgeries for unilateral procedures, which is 0.03%, or one case of endophthalmitis for every 3,000 operations, a statistically significant difference. Dr Montan said that the difference may potentially be due to selection bias, with younger and healthier patients being chosen for bilateral surgery. Using multivariate analysis, he reported that the endophthalmitis rate was 5.4 times higher in the case of capsular rupture, 5.0 times higher in the case of no intracameral antibiotics, 1.9 times higher for patients aged 85 or older and only half for bilateral surgery as compared to controls. While the regression analysis showed that bilateral surgery was an independent protective factor against endophthalmitis, Dr Montan cautioned against reading too much into this. “We need to dig more into the age factor as we know that patients undergoing same-day bilateral surgery are much younger than the rest. Surgical difficulties may also have an impact as this was an item introduced to the registry only since 2008. We are also using different intracameral antibiotics so that might be interesting to study in that context. There are also surgeon factors that may potentially be extracted from the registry because we know that the experience of the surgeon plays a role,” he concluded.
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Per Montan: per.montan@sll.se EUROTIMES | MARCH 2020
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