Incidence, Prophylaxis and Prognosis of Acute Postoperative Endophthalmitis After Cataract Surgery: A Multicenter Retrospective Analysis in Northern China from 2013 to 2019

Figures & data

Table 1 Incidence of Acute POE Among Different Years and Hospitals

	No. of Cataract Surgeries (n)	No. of Endophthalmitis (n)	Incidence of Endophthalmitis (95% CIs)
Year
2013	7207	4	0.056% (0.001%, 0.110%)
2014	8255	3	0.036% (0, 0.078%)
2015	8925	3	0.034% (0, 0.072%)
2016	10,684	4	0.037% (0.001%, 0.074%)
2017	11,602	2	0.017% (0, 0.041%)
2018	11,738	2	0.017% (0, 0.041%)
2019	13,844	1	0.007% (0, 0.021%)
Mantel–Haenszel test: p=0.021^※
Hospital
A	31951	8	0.025% (0.008%, 0.042%)
B	31335	4	0.013% (0, 0.025%)
C	2799	1	0.036% (0, 0.106%)
D	2790	1	0.036% (0, 0.106%)
E	454	0	0
F	2555	5	0.196% (0.024%, 0.367%)
G	371	0	0
Total	72,255	19	0.026% (0.015%, 0.038%)

Note: ^※Represents the p value for Mantel–Haenszel test was less than 0.05, which suggests the annual incidence of acute POE after cataract surgery changed over years.

Abbreviations: POE, postoperative endophthalmitis; CI, confidence interval.

Figure 1 The trends of the incidence of acute POE (postoperative endophthalmitis) over years among different hospitals. The black arrow: time point when 5% PVP-I (povidone-iodine) started to be used in Hospital-A. The gray arrow: time point when 0.5% PVP-I started to be used in Hospital-F. “※” represents the p value for comparing the incidences of POE before and after the usage of PVP-I was less than 0.05, which suggests the incidence of postoperative endophthalmitis significantly decreased in Hospital-F after the application of 0.5% PVP-I.

Table 2 Perioperative Infection Prophylaxis in Each of Hospitals

		Hospital-A	Hospital-B	Hospital-C	Hospital-D	Hospital-E	Hospital-F	Hospital-G
Pre-operative	Topical antibiotics	0.5% LVX	0.5% LVX	0.3% GAT	0.5% LVX	0.3%TOB	0.5% LVX	0.5% LVX
	Conjunctiva sac washing	5% PVP-I (2017–2019) TOB (2mg/100mL) (2013–2016)	5% PVP-I	0.5%PVP-I	0.5%PVP-I	0.5% PVP-I	0.5% PVP-I (2016–2019) TOB (2mg/100mL) (2013–2015)	0.1%PVP-I
Intra-operative	Antibiotics in irrigation solutions	—	TOB 4mg/1000mL^※	—	—	TOB 8mg/1000mL^※	—	—
	Intracameral antibiotics	—	—	—	—	—	—	—
	Subconjunctival antibiotics	—	—	—	—	—	—	—
	Ophthalmic ointment	0.3%TOB+ 0.1%DEX	0.3%TOB+ 0.1%DEX	0.3%TOB+ 0.1%DEX	0.3%TOB+ 0.1%DEX	0.3%TOB+ 0.1%DEX	0.3%TOB+ 0.1%DEX	0.3%TOB+ 0.1%DEX
Post-operative	Topical antibiotics	0.5% LVX	0.5% LVX	0.3%GAT	0.3%TOB	0.3%TOB	0.5% LVX	0.3%TOB
Incidence of acute POE		0.025%	0.013%	0.036%	0.036%	0	0.196%	0

Note: ^※Represents that Hospital-B and E adopted tobramycin in the irrigation solution and achieved a significant lower incidence than the other hospitals where no antibiotics were administrated in the irrigation solution (p = 0.044).

Abbreviations: LVX, levofloxacin; TOB, tobramycin; DEX, dexamethasone; GAT, gatifloxacin; PVP-I, povidone-iodine; POE, postoperative endophthalmitis.

Table 3 Analysis of Potential Prognostic Factors for Final Visual Outcome in POE Patients

Predictors		Number of Cases (n)	Unfavorable Vision (n)	p-value
Sex	Male	9	5	0.838
	Female	6	3
Age	≤70 years	8	6	0.082
	>70 years	7	2
DM	With DM	8	5	0.462
	Without DM	7	3
Time to onset	≤7 days	12	7	0.453
	>7 days	3	1
Presenting BCVA	CF or better	3	0	0.046^※
	HM or worse	12	8
Antibiotics	Combined antibiotics (V+C)	7	4	0.789
	Single antibiotics (V)	8	4
PPV	PPV performed	6	4	0.414
	No PPV	9	4
Culture	Positive	3	2	0.626
	Negative	10	5

Note: ^※Represents the p value for analysis of prognostic factors was less than 0.05, suggests that patients with presenting BCVA of CF or better were less likely to present with unfavorable final vision than those with presenting BCVA of HM or worse.

Abbreviations: POE, postoperative endophthalmitis; DM, diabetes mellitus; BCVA, best corrected visual acuity; CF, counting fingers; HM, hand motions; V, vancomycin; C, ceftazidime; PPV, pars plana vitrectomy.