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Sutureless clear corneal cataract incisions, endophthalmitis linked, review finds

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A broad-based literature review covering 4 decades found that the incidence of endophthalmitis following cataract surgery has increased during the past decade. The authors of the review noted that this upward trend coincided with the popularization of sutureless clear corneal incisions for cataract surgery.

The effect of incision style on the incidence of post-cataract endophthalmitis has been the subject of debate in recent years. The review authors noted that previous studies have theorized that the stability of clear corneal incisions may be related to the incidence of endophthalmitis.

To investigate this possible relationship, Mehran Taban, MD, and colleagues conducted a review of articles published from 1963 to 2003 that related to cataract surgery and endophthalmitis. The study authors found 215 studies that addressed endophthalmitis. They then analyzed pooled incidence rates and relative risks of developing endophthalmitis using different incision techniques.

A total of 3.1 million cataract extractions were documented in the studies analyzed, with an overall rate of 0.128% for endophthalmitis after cataract surgery. The incidence of acute endophthalmitis changed over time, with a “significant increase” since 2000 when compared to earlier decades, the authors said. From 2000 to 2003, the rate of endophthalmitis was 0.265%, compared with 0.085% in the 1990s, 0.158% in the 1980s and 0.327% during the 1970s.

The authors extrapolated data on incision type from 57 of the studies, including a total of 421,940 procedures. Endophthalmitis after clear corneal cataract extraction from 1992 to 2003 was 0.189%, compared with 0.074% for scleral incisions and 0.062% for limbal incisions during the same time period.

“The lack of conjunctiva covering the clear corneal incisions and a possible increased technical difficulty in constructing a stable, self-sealing incision in the cornea compared with the sclera may contribute to an elevated risk of endophthalmitis with clear corneal incisions relative to scleral tunnel incisions,” the researchers said.

They recommended the use of a suture to seal the wound “if there is any question about the self-sealing properties of a clear corneal cataract incision.”

The article is published in the May issue of the Archives of Ophthalmology.