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Postoperative Endophthalmitis Before and After Preferred Utilization of Prophylactic Intracameral Antibiotics for Phacoemulsification Cataract Surgeries at Cole Eye Institute

Li, Ang M.D.; Shao, Jack M.D.; Gans, Richard M.D.; Bena, James M.S.; Goshe, Jeffrey M.D.

doi: 10.1097/ICL.0000000000000569

Purpose: To compare the rate of endophthalmitis of intracameral versus topical antibiotic prophylaxis for patients undergoing phacoemulsification at a single-centered, multispecialty ophthalmological institute.

Methods: A retrospective analysis of the rate of endophthalmitis by coding search within 90 days of cataract surgery in periods before (May 15, 2012–May 15, 2014) and after (April 30, 2015–April 30, 2017) intracameral antibiotics became the institution's preferred practice pattern for phacoemulsification. Clinical data were collected for each endophthalmitis case, including timing of onset, presenting symptoms and signs, culture results, treatment performed, and visual acuity outcome.

Results: The rate of postphacoemulsification endophthalmitis decreased from 0.18% (29 eyes among 16,201 cataract surgeries) to 0.07% (11 eyes among 16,325 surgeries) when the preferred method was changed from topical to intracameral antibiotics (P=0.004) with an odds ratio of 0.32. Endophthalmitis cases in the 2 groups had comparable visual acuity at initial presentation and at 3 months (P=0.86). The most commonly isolated organism in culture-proven cases of endophthalmitis in both groups was coagulase-negative staphylococcus. The rate of gram-positive endophthalmitis decreased from 0.08% to 0.02% with an odds ratio of 0.23 (P=0.012) while the rate of gram-negative cases remained similar.

Conclusions: The use of intracameral antibiotics during cataract surgery was associated with a statistically significant reduction of postoperative endophthalmitis.

Department of Ophthalmology (A.L., J.S., R.G., J.G.), Cleveland Clinic, Cole Eye Institute, Cleveland, OH; and Department of Statistics (J.B.), Cleveland Clinic Foundation, Cleveland, OH.

Address correspondence to Ang Li, M.D., Cole Eye Institute, 2022 East 105th Street, Cleveland, OH 44106; e-mail:

The authors have no funding or conflicts of interest to disclose.

Accepted November 12, 2018

© 2019 Contact Lens Association of Ophthalmologists, Inc.