Eyeworld

EW INTERNATIONAL 96 February 2017 by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer to 1998 in the face of technological and postoperative care changes in higher and lower socioeconomic categories in Indian patients showed 0.13% clinical and 0.07% culture- positive endophthalmitis rates. 1 It concluded that ambulatory cataract surgery carried additional risk for postoperative infection in lower socioeconomic groups. Interestingly, even the more recent investigations in the literature review demonstrat- ed similarly low endophthalmitis rates. The largest and longest of the documented investigations was a prospective study conducted at a ter- tiary care eye hospital that compiled data from 2000 to 2007 on the mi- crobiology, incidence, and probable sources of infection from 131,904 patients. It showed that the inci- dence of culture-positive endoph- thalmitis was 0.05% and noted that infections mostly occurred following cataract and penetrating keratoplas- ty surgeries. 2 Fungi were reported as causative agents in as few as 7% and in as many as 22% of cases of endoph- thalmitis in India. The most com- mon fungus was Aspergillus, seen almost exclusively in most studies, followed by Candida. The most com- mon bacteria seen in infections were S. epidermidis, P. aeruginosa, S. aureus, and Nocardia. Some of the studies in the review that looked at larger patient groups over the course of several years showed analogous outcomes. For instance, a retrospective review of microbiological records from 1995 to 1998 noted endophthalmitis in 382 individuals, of which 44.5% were culture positive, breaking down into 37.6% gram positive cocci (GPC), 41.7% gram negative bacteria (GNB), and 21.8% fungi (Aspergil- lus). 3 Another 5-year investigation documented endophthalmitis in 62 individuals, of which 58.06% were culture positive. They found 64.8% GPC, 24.3% GNB, mostly S. epider- midis and P. aeruginosa and 2.7% fungi, mostly Aspergillus. 1 Studies that focused on the clinical presentation and accurate diagnosis of fungal endophthalmitis infections found that they largely mimicked bacterial infections in their early onset and diffuse presen- tation, stressing the importance of both bacterial and fungal cultures LV Prasad Eye Institute, Hyderabad, India, and the Aravind Eye Hospital, Madurai and Pondicherry, India, and factored into the results from the literature. The study identified 99 pub- lished articles from India within the past 20 years, six of which described the incidence of in-house endoph- thalmitis following cataract surgery. The acute post-cataract surgery endophthalmitis rate was 0.04% to 0.15%, compared to the global rate of 0.02% to 0.26%. The incidence of in-house endophthalmitis in the two large participating eyecare facilities was 0.02% to 0.08% culture positive, and 0.05% to 0.16% clinical. According to the studies re- viewed, bacteria were more common in south India and fungi more com- mon in north India. Pseudomonas aeruginosa was the major organism identified in cluster infections. Incidence An early retrospective case-con- trolled study published by Dr. Das that documented endophthalmitis in 46,095 cataract cases from 1993 microbiology of acute post-cataract surgery endophthalmitis in India over the past two decades from published reports. Although the data collection is not very robust in India, many large eyecare providers, from both public and non-profit facilities, have published several seminal reports. Nonetheless, there is an urgent need for more reports from all institutes across different regions of India." Data collection To gain a better understanding of the extent of post-cataract endoph- thalmitis, Dr. Das and his colleagues conducted a systematic literature review of all English language PubMed-referenced articles pub- lished between 1992 and 2012, documenting the incidence and microbiology spectrum of acute post-cataract surgery endophthalmi- tis in India. In addition, the clinical and microbiology records from half a million cataract surgeries were re- viewed from a 5-year period between January 2010 and December 2014 from two large eyecare facilities, the Documented incidence in India is proportionate to worldwide incidence, study shows A new report indicates that the incidence of pre- sumed endophthalmitis following cataract surgery in India is comparable to most of the developed world, despite performing high volume cataract surgery. The results suggest that the implemented techniques and proto- cols enhance the quality of out- comes. Retina specialist Taraprasad Das, MD, LV Prasad Eye Institute, consultant at Smt. Kanuri San- thamma Centre for Vitreo Retinal Diseases, Hyderabad, India, called for better documentation of Indian surgical data. "A uniform documen- tation of endophthalmitis will help make a good guideline in India," Dr. Das said in a poster presentation he gave on behalf of his collaborators at the 2016 American Academy of Ophthalmology annual meeting. "We reviewed the incidence and Endophthalmitis rate low in India Presentation spotlight Hypopyon and cells in the anterior chamber; hazy vitreous view; causative organism was Staphylococcus epidermidis Source: Taraprasad Das, MD

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