Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors.
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چکیده
PURPOSE To identify risk factors and describe the effects of antibiotic prophylaxis on the incidence of postoperative endophthalmitis after cataract surgery based on analysis of the findings of the European Society of Cataract & Refractive Surgeons (ESCRS) multicenter study. SETTING Twenty-four ophthalmology units in Austria, Belgium, Germany, Italy, Poland, Portugal, Spain, Turkey, and the United Kingdom. METHODS A prospective randomized partially masked multicenter cataract surgery study recruited 16 603 patients. The study was based on a 2 x 2 factorial design, with intracameral cefuroxime and topical perioperative levofloxacin factors resulting in 4 treatment groups. The comparison of case and non-case data was performed using multivariable logistic regression analyses. Odds ratios (ORs) associated with treatment effects and other risk factors were estimated. RESULTS Twenty-nine patients presented with endophthalmitis, of whom 20 were classified as having proven infective endophthalmitis. The absence of an intracameral cefuroxime prophylactic regimen at 1 mg in 0.1 mL normal saline was associated with a 4.92-fold increase (95% confidence interval [CI], 1.87-12.9) in the risk for total postoperative endophthalmitis. In addition, the use of clear corneal incisions (CCIs) compared to scleral tunnels was associated with a 5.88-fold increase (95% CI, 1.34-25.9) in risk and the use of silicone intraocular lens (IOL) optic material compared to acrylic with a 3.13-fold increase (95% CI, 1.47-6.67). The presence of surgical complications increased the risk for total endophthalmitis 4.95-fold (95% CI, 1.68-14.6), and more experienced surgeons were more likely to be associated with endophthalmitis cases. When considering only proven infective endophthalmitis cases, the absence of cefuroxime and the use of silicone IOL optic material were significantly associated with an increased risk, and there was evidence that men were more predisposed to infection (OR, 2.70; 95% CI, 1.07-6.8). CONCLUSIONS Use of intracameral cefuroxime at the end of surgery reduced the occurrence of postoperative endophthalmitis. Additional risk factors associated with endophthalmitis after cataract surgery included CCIs and the use of silicone IOLs.
منابع مشابه
Clinical observations associated with proven and unproven cases in the ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery.
PURPOSE To describe cases of postoperative endophthalmitis in the European Society of Cataract & Refractive Surgeons (ESCRS) study of the prophylaxis of endophthalmitis, compare characteristics of unproven cases and cases proven by culture or polymerase chain reaction, and compare the characteristics with those in other reported series. SETTING Twenty-four ophthalmology units in Austria, Belg...
متن کامل[The ESCRS study on antibiotic prophylaxis for endophthalmitis following cataract surgery].
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Roibeard O’hEineachain in London INSPIRED by the findings of the ESCRS endophthalmitis study, a symposium at the XXIV Congress of the ESCRS in London addressed the topic of endophthalmitis
INSPIRED by the findings of the ESCRS endophthalmitis study, a symposium at the XXIV Congress of the ESCRS in London addressed the topic of endophthalmitis following cataract surgery.The Symposium was chaired by Ulf Stenevi and Jose Güell. Presenters provided updates on the current knowledge in the aetiology, diagnosis and treatment of endophthalmitis, and also provided suggestions on how the c...
متن کاملIntracameral vancomycin following cataract surgery: An eleven-year study
AIM To compare the incidences of endophthalmitis after cataract operations before and after introduction of intracameral vancomycin at the end of surgery. METHODS A retrospective analysis was performed of presumed infectious endophthalmitis after cataract surgery from January 1, 1998 to December 31, 2008. From January 2001, the practice of using intracameral vancomycin at the end of cataract ...
متن کاملCataract Surgery Feature Story
RICHARD B. PACKARD, FRCS , FRCOPHTH The issue of appropriate prophylaxis to minimize the risk of endophthalmitis after cataract surgery has long vexed ophthalmic surgeons. Most reports on series of patients have either been retrospective or had insufficient numbers to provide genuinely statistically sound data. The ESCRS has just closed its very large prospective study early, because one arm sh...
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ورودعنوان ژورنال:
- Journal of cataract and refractive surgery
دوره 33 6 شماره
صفحات -
تاریخ انتشار 2007