Endophthalmitis following cataract surgery and effect of different intracameral antibiotic regimes in Sweden 2011 – 2017. A national registry study

Abstract

Purpose: To study the incidence, predictive factors, aetiology and visual consequences of postoperative endophthalmitis (PE) in relation to three intracameral antibiotic regimes. Setting: Swedish National Cataract Register (NCR) entries from 2011 through 2017. Design: Observational retrospective study. Methods: PE incidence, influencing factors, bacteriology and visual outcome were analyzed with regard to the three major prophylactic IC protocols. Results: The overall incidence of PE was 0.023% or 177 cases in 764 513 cataract procedures. Analyzed per intracameral regime, the rates of PE were 0.024% (126 cases in 514 916 surgeries) for cefuroxime, 0.020% (25 cases in 122 340 surgeries) for moxifloxacin and 0.017% (20 cases in 121 045 surgeries) for combined cefuroxime-ampicillin. Incidences were not statistically significantly different from one another. Gram-positive bacteria caused 89.0% of culture positive cases. Enterococci as pathogens were significantly more frequent with intracameral cefuroxime than with moxifloxacin, p = 0.006 or cefuroxime-ampicillin, p < 0.001, while streptococci other than enterococci were more common with moxifloxacin than with cefuroxime, p < 0.001. Bacterial susceptibility to the given antibiotics was demonstrated in 21.3% of PE cases treated with cefuroxime, which was statistically significantly lower than proportions found with cefuroxime-ampicillin, 60.0%, p = 0.015, or with moxifloxacin, 88.2%, p < 0.001. Visual outcome worse than 20/200 were similar in the groups ranging from 42.0% to 53.7%. Conclusion: No statistically significant differences in PE incidence or visual outcome results between treatment groups were demonstrated. However, differences in aetiology and bacterial sensitivity were found between the prophylactic intracameral treatments.