Swollen lids, pain and opaque vitreous statistically linked to postop endophthalmitis

J Cataract Refract Surg. 2009;35(9):1523-1531.

Swollen lids, pain and opaque vitreous were strongly associated with confirmed postoperative endophthalmitis, according to a study.

In the European Society of Cataract and Refractive Surgeons study of the prophylaxis of endophthalmitis, investigators used univariable and multivariable logistic regression models to analyze statistical association of signs and symptoms in cases with confirmed or unconfirmed endophthalmitis.

This analysis included data from 29 endophthalmitis cases; 20 cases were proven and nine cases were not proven. The median interval to presentation with signs and symptoms was 4.5 days in proven cases and 9 days in unproven cases.

After multivariable logistic regression modeling, swollen lids and opaque vitreous were strongly associated with proven cases of endophthalmitis.

Eight cases caused by streptococcal infection were associated with pain, hypopyon, chemotic conjunctiva and clear corneal incisions.

Visual outcomes varied between streptococcal and staphylococcal infections; outcomes were significantly worse in streptococcal cases.

Final postoperative visual acuity in 11 staphylococcal cases ranged from 20/20 to 20/80, with no patients deemed legally blind. Final visual acuity in eight streptococcal cases ranged widely, from 20/20 to no light perception; five patients were deemed legally blind.

"To date, intracameral cefuroxime remains the only prophylactic intervention proven to reduce rates of endophthalmitis after cataract surgery," the study authors said.