Postoperative endophthalmitis remains one of the most feared complications of cataract surgery. Historically, most cataract surgeons have generally waited a week or more after cataract surgery on one eye before proceeding with surgery on the contralateral eye, in part to avoid the possibility of bilateral endophthalmitis. However, recovery from cataract surgery can be a burden for patients, many of whom may prefer to recover from surgery on both eyes during the same time period. Same-day bilateral cataract surgery has become more widely practiced over the last decade. Recently, two publications explored the risk of postoperative endophthalmitis following immediate sequential bilateral cataract surgery.
In a study of the Swedish National Cataract Registry over a 16-year period, 422 cases of postoperative endophthalmitis following 1,457,172 cataract surgeries were identified. Immediate sequential bilateral cataract surgery was performed in 92,238 operations with endophthalmitis occurring after 14 cases, giving a rate of 0.0152%. Unilateral cataract surgery resulted in an endophthalmitis rate of 0.0299%, which reached statistical significance for a higher rate of infection (P = .01). Following same-day bilateral surgery, one 93-year-old patient developed bilateral infection.
In a study of the American Academy of Ophthalmology Intelligent Research in Sight (IRIS) Registry database, 3,102 cases of endophthalmitis following 5,573,639 cataract surgeries were identified. A total of 165,609 patients underwent immediate sequential bilateral cataract surgery. Rates of endophthalmitis were similar between the two groups (0.059% unilateral surgery vs. 0.056% bilateral immediate surgery, P = .53). Seven cases of endophthalmitis in the bilateral surgery group were identified.
Same-day bilateral endophthalmitis remains a small proportion of the total patients undergoing cataract surgery in both Sweden and the United States. Rates of endophthalmitis remain low with similar risk following unilateral or same-day bilateral surgery. Surgeons can reasonably offer patients same-day cataract surgery, although bilateral endophthalmitis following surgery remains a risk.
April 2022: VBS Literature Update
Lacy M, Kung T, Owens J, et al. Endophthalmitis rate in immediately sequential versus delayed sequential bilateral cataract surgery within the IRIS registry data. Ophthalmology. 2022;129(2):129-38.
Friling E, Johansson B, Londsteom M, et al. Postoperative endophthalmitis in immediate sequential bilateral cataract surgery: a nationwide registry study. Ophthalmology. 2022;129(1):26-34.
Abstract by Philip Storey, MD, MPH
Upon completion of this activity, the participant should be able to:
Provided by Evolve Medical Education
Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Evolve Medical Education, LLC and Vit Buckle Society. Evolve Medical Education, LLC is accredited by the ACCME to provide continuing medical education for physicians.
Credit Designation Statement
Evolve Medical Education LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
In order to obtain credit, proceed through the program, complete the post-test, evaluation and submit for credit.
Philip Storey, MD, MPH
Austin Retina Associates
Austin, Texas
DISCLOSURE POLICY
It is the policy of Evolve that faculty and other individuals who are in the position to control the content of this activity disclose any real or apparent financial relationships relating to the topics of this educational activity. Evolve has full policies in place that will identify and mitigate all financial relationships prior to this educational activity.
The following faculty/staff members have the following financial relationships with ineligible companies.
Philip Storey, MD, MPH, has had no financial relationships with an ineligible company.
The Evolve staff and planners have no financial relationships with ineligible companies.
Nisha Mukherjee, MD, peer reviewer, has no financial relationships with ineligible companies.
OFF-LABEL STATEMENT
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The opinions expressed in the educational activity are those of the faculty. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
DISCLAIMER
The views and opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of Evolve or the Vit Buckle Society.
Expiration Date:
Ready to Claim Your Credits?
You have attempts to pass this post-test. Take your time and review carefully before submitting.
Good luck!
David Boyer, MD
Diana V. Do, MD
Marion Munk, MD, Ph.D
Diana V. Do, MD
Diana V. Do, MD
Marion Munk, MD, Ph.D
