Abstract
Aims
To study risk factors for presumed infectious endophthalmitis complicating cataract surgery in the United Kingdom.
Methods
Two hundred and fourteen clinically diagnosed patients with presumed infectious endophthalmitis were compared with 445 control patients throughout the United Kingdom in a prospective case–control study. The cases were identified through the British Ophthalmological Surveillance Unit reporting card system. Control patients undergoing cataract surgery from 13 ‘control centres’ throughout the United Kingdom were selected randomly. Risk factors were identified by univariate and multivariate logistic regression analyses. Pertinent variables relating to the cataract extraction procedure, antimicrobial prophylaxis, ophthalmic and medical history were analysed with regard to postoperative infection.
Results
Statistically significant risk factors in the multivariate model included inpatient cataract surgery (P=0.001), surgery in dedicated eye theatres (P<0.001), consultant grade surgeon (compared to registrar) (P=0.001), posterior capsule tear during cataract surgery (P=0.001). The use of face masks by the scrub nurse and surgeon during cataract surgery (P<0.001) and the administration of subconjunctival antibiotics at the end of surgery (P<0.001) were protective against postoperative infection.
Conclusions
In order to minimise the risk of postoperative endophthalmitis we would recommend the wearing of face masks by the surgeon and scrub nurse during cataract surgery and subconjunctival antibiotics at the end of surgery.
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Acknowledgements
We gratefully acknowledge the data contribution to this study of approximately 200 ophthalmologists throughout the UK. In addition, we thank the control centers for providing data on the controls: Wycombe General Hospital, Central Middlesex Hospital, St George's Hospital, Bristol Eye Hospital, Musgrove park Hospital-Taunton, Royal United Hospital-Bath, Southport and Formby District General Hospital, Furness General Hospital, West Cumberland Hospital, Leeds General Infirmary, Alexandra Hospital-Redditch, Coventry and Warwickshire Hospital, and Princess Alexandra Eye Pavilion-Edinburgh. We are very grateful for the support of the British Ophthalmological Surveillance Unit. This project was also supported by the British Medical Association Middlemore award 1999 and the John William Clarke award 2000.
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Presented at the Royal College of Ophthalmologists meeting, Birmingham, May 2003
Conflict of interest: Nil.
Ethics approval: Approval from the Local Ethics Committee, Belfast and the South West Multicentre Research Ethics Committee.
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Kamalarajah, S., Ling, R., Silvestri, G. et al. Presumed infectious endophthalmitis following cataract surgery in the UK: a case–control study of risk factors. Eye 21, 580–586 (2007). https://doi.org/10.1038/sj.eye.6702368
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DOI: https://doi.org/10.1038/sj.eye.6702368
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