Acute postoperative endophthalmitis after resurgery following primary cataract surgery: 9 years experience from a tertiary eyecare center

Purpose: To report the incidence, risk factors, and visual outcomes of acute postoperative endophthalmitis in patients undergoing resurgery after cataract surgery.

Setting: Tertiary eye hospital in southern India.

Design: Retrospective, clinical registry.

Methods: Medical records of patients were retrospectively reviewed from January 2010 to December 2018. Incidence, risk factors, causative organisms, management, and outcomes were studied. Patients who underwent resurgery within 6 weeks of primary cataract surgery and developed endophthalmitis within 6 weeks of resurgery were included.

Results: A total of 5705 patients (0.64%) underwent resurgery. Of 5705 resurgeries, 11 patients (0.19%) developed postoperative endophthalmitis. The incidence of endophthalmitis was higher in the eyes having a breach in the posterior capsule than the eyes with no breach in the posterior capsule (10/1277 [0.78%] vs 1/4428 [0.02%]). Among the 11 patients, secondary intraocular lens (IOL) implantation was the most common indication for resurgery (9/11 [82%]) after which endophthalmitis occurred. Three (27.3%) of the 11 patients were culture-positive. Nine (82%) of 11 patients were managed with a vitreous tap along with intravitreal antibiotics and steroid injections. After treatment, 80% of the patients achieved a visual acuity of 6/18 or greater (logMAR 0.5, P value < .05). None of the eyes developed phthisis bulbi.

Conclusions: Eyes having a breach in the posterior capsule requiring vitrectomy and taken for resurgery as secondary IOL implantation were having an increased risk for endophthalmitis. The posttreatment visual outcomes were favorable.