Attention to detail throughout cataract surgery lowers rates of infection

MAUI, Hawaii — The rates of endophthalmitis are on the rise in the United States, said I. Howard Fine, MD, here at the Hawaii 2003: the Royal Hawaiian Eye Meeting. “We have to realize that when we’re doing more surgery, we’re going to see more complications,” said Dr. Fine.

Other factors that influence the rise in postoperative endophthalmitis include higher rates of resistance to antibiotics, as well as the emphasis on faster surgical procedure. “In our practice, we have not have one incidence of postoperative endophthalmitis in 4,000 cases over 5 years,” said Dr. Fine. “I don’t think that this is due to good luck. I think it’s due to a concerted effort to pay attention to detail at the time of surgery.” It is crucial that surgeons take their time and not be overly aggressive in their techniques, he said.

When performing cataract extraction, surgeons must carefully prepare the surgical field, use viscoelastic, and make an incision that will promote sealing.

Dr. Fine offered suggestions to help surgeons prepare for surgery. “Many studies have shown that the use of 5% povidone-iodine preoperatively results in lower bacterial count in the operative field and lower incidences in endophthalmitis,” he said.

“We make all of our incisions temporally,” Dr. Fine said. He attributes improved endothelial pumping and better sealing to incision.

“The best way to prevent endophthalmitis is to pay attention to detail,” said Dr. Fine.