Endophthalmitis after cataract surgery: results from seven years of epidemiological surveillance

Abstract Purpose: This study aims to describe the incidence, clinical presentation, and evolution of endophthalmitis cases occurred at an ophthalmologic center in Brazil. Methods: This is a review of medical records of patients undergoing cataract surgery from 2008 to 2014. Clinical variables associated with the outcome of postoperative endophthalmitis were evaluated. Results: during the study period, 27,609 cataract surgeries were performed. It was identified 35 cases of endophthalmitis. The overall incidence of endophthalmitis was 0.13%, with an annual variation from 0.04% to 0.27%. The main signs and symptoms in patients with endophthalmitis were ocular pain and low visual acuity associated with conjunctival hyperemia and hypopyon. Gram-positive microorganisms were the most frequent etiological agents. All patients received an intra-vitreous injection of antibiotics as immediate treatment. The final visual acuity was equal to or worse than the ability to count the examiner's fingers in 57.1% of the patients. Evisceration or enucleation was required in 3 patients. Conclusion: The incidence of endophthalmitis and the majority of signs and symptoms found in this study were in agreement with literature in the field. Although the incidence rate is low, the loss of vision experienced by most patients with endophthalmitis after cataract surgery highlights the need for efforts to prevent infection and early diagnosis to avoid such complications.

【摘要】目的：本研究旨在描述巴西某眼科中心收治的眼内炎（endophthalmitis）病例的发病率、临床表现及病程转归。方法：本研究为回顾性病历分析，纳入2008年至2014年期间接受白内障手术（cataract surgery）的患者病历，评估与术后眼内炎预后相关的各类临床变量。结果：研究周期内，该中心共完成27609例白内障手术，确诊眼内炎病例35例。总体眼内炎发病率为0.13%，年度发病率波动区间为0.04%至0.27%。眼内炎患者的主要临床症状与体征包括眼痛、视力低下，伴随结膜充血与前房积脓（hypopyon）。革兰阳性微生物为最常见的致病病原体。所有患者均接受玻璃体内注射（intra-vitreous injection）抗生素作为初始治疗方案。57.1%的患者最终视力降至数指水平及以下。3例患者需接受眼内容剜出术（evisceration）或眼球摘除术（enucleation）。结论：本研究报道的眼内炎发病率及多数临床表现与该领域现有文献研究结果一致。尽管整体发病率较低，但白内障术后眼内炎患者大多出现视力丧失，这凸显了加强感染预防与早期诊断工作、以规避此类并发症的必要性。