Miño de Kaspar H., Grasbon T., Fröhlich S. J., Binder C. A., Schaller U. C., Thiel M.

Department of Ophthalmology, Ludwig-Maximilians-University, Munich

Purpose: The study was made to assess, whether there is a decrease in the incidence of postoperative endophthalmitis after the changes made to reduce bacterial contamination during intraocular surgery.
Methods: The incidence of postoperative endophthalmitis was assessed per year from 1989 to 1999. During this time period, new microbiologic preoperative regiments were introduced to minimize the risk of endophthalmitis. These include: a) Conjunctival culture smears taken one day prior to surgery in patients at high risk for developing endophthalmitis. These patients were treated with topical antibiotics until culture smears were negative before proceeding to surgery. b) High risk patients received prophylactic intravenous antibiotics in addition to topical antibiotics. c) The periorbital area was prepared with 10% povidone-iodine for five minutes followed by flushing of the conjunctiva with 10ml of 1% povidone-iodine for all patients. d) Disinfection of the vacuum control manifold in automated surgery equipment. Besides, since 1994 the extracapsular cataract extraction was converted to the phacoemulsification surgery.
Results: The incidence of postoperative endophthalmitis per year ranged between 0.42% and 0.03%. Over time, a significant decrease (one-tailed Cox and Stuart`s test, p<0.05) was found.
Discussion: The changes made in an attempt to significantly reduce bacterial contamination, along with the conversion from extracapsular cataract extraction to small-incision surgery/phacoemulsification, appear to reduce the incidence of postoperative endophthalmitis.

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