Cataract surgery is considered to be one of the safest and most commonly performed surgeries throughout the world. The risk of infection with cataract surgery is usually very low, however infections do still occur and when they do it is typically a postoperative infection called endophthalmitis.
What is Postoperative Endophthalmitis?
The medical description of postoperative endophthalmitis is a severe inflammation of both the anterior (front 1/3) and posterior (back 2/3) segments of the eye. A case of postoperative endophthalmitis happens when a bacterial organism finds it’s way into the eye either through contaminated surgical instruments or from a patient’s own tissues. After the infection accesses the vitreous cavity (area in the back of the eye that houses the jelly-like vitreous fluid), it rapidly reproduces, advancing the inflammation to an extremely painful level.
Postoperative Endophthalmitis – Symptoms
Postoperative endophthalmitis infections are characteristically easy to diagnose. Typically occurring within the first six weeks after cataract surgery, a patient may experience a sudden decrease in vision, pain, extensive redness, swelling of the eyelids, and light sensitivity in postoperative eye.
Postoperative Endophthalmitis – Diagnosis
After cataract surgery, if any symptoms of endophthalmitis are shown, an emergency appointment with an ophthalmologist is required to prevent any permanent vision loss. At the ophthalmologist’s office some or all of the following tests may be done:
-Vision check (each eye independently, not just the surgery eye)
-Slit lamp exam
-B-Scan (ultrasound of the eye – done with the patient’s eye closed)
Of all of the above-mentioned testing, only the vitreous tap is slightly invasive. By removing a small sample if the vitreous fluid, an ophthalmologist can culture the bacteria and determine the best treatment.
Postoperative Endophthalmitis – Treatments
Once a diagnosis of postoperative endophthalmitis has been made, the patient may be treated with one of more of the following ways:
Topical antibiotic drops
Topical antibiotic drops is less of a treatment for the postoperative endophthalmitis infection and more as a prevention or treatment of a wound infection on the surface of the eye from the cataract surgery, Occasionally it is this wound that was the entrance way for the bacteria in the first place.
Injection of antibiotics into the vitreous cavity
Injection of antibiotics directly into the vitreous cavity of the eye is the standard of care for patients with postoperative endophthalmitis after cataract surgery. Using a strong antibiotic, such as Vancomycin, the medication is injected directly into the area of highest infection, bringing the antibiotic medication directly to the source. Like the vitreous tap, the eye is completely numbed and the needle used is very small..
Intravenous injections of antibiotics, like Vancomycin, are recommended for patient with severe postoperative endophthalmitis or in patients with compromised immune systems.
Injection of corticosteroids into the vitreous cavity
As a way of quickly reducing the inflammation caused by postoperative endophthalmitis after cataract surgery, an ophthalmologist may choose to inject corticosteroids into the vitreous cavity in addition to the antibiotics. This may also aid in the healing process.
If all other treatment options fail to bring about a complete resolution of the postoperative endophthalmitis infection, a vitrectomy surgery may need to be performed. This surgical procedure is done in a sterile operating room and involves the removal of part or all of the infected vitreous fluid. The fluid is then replaced with a sterile saline solution, which the body will replace as it creates its own natural fluid.
Postoperative Endophthalmitis – Prognosis and Prevention
Ultimately the goal with cataract surgery is to have a successful outcome without any infection. This can best be done with good preparation and some pre and postoperative precautions.
The standard of care is to have those scheduled for cataract surgery to be on a series of topical eye drops both before and after surgery. These drops are used as defensive measures designed to prevent postoperative infections like endophthalmitis. If you are unsure of what eye drops to use, how often, or when to start or stop them, call your surgeon’s office immediately.
In addition to the physical precautions, it is important to be mentally prepared. When discussing cataract surgery with your ophthalmologist, they will go over any risks of benefits of the surgery as they pertain to your case. If you are unclear on any of the points, or have questions no covered in what they initially discuss, ask. A good physician will take all the time and effort that is required to help you be comfortable with your choice to have cataract surgery.
If treated promptly by an ophthalmologist the prognosis of a recovery is a good one. According to a study conducted by the French Institutional Endophthalmitis Study Group and reported by National Institute of Health, over 50% of people who contracted a postoperative endophthalmitis infection as a result of cataract surgery recovered vision to at least 20/40. Statistically, out of the millions of cataract surgeries preformed every year, only 0.07% to 0.3% of patients get a postoperative endophthalmitis infection. This, along with the high recovery rate, show very few people become blind as a result of the infection.
As stated, postoperative endophthalmitis cases after cataract surgery are a rare occurrence, but still a risk. Follow your ophthalmologist’s instructions and report any concerning symptoms to your doctor to assure proper treatment of any potential infection.
C. Chiquet, A. Pechinot, C. Creuzot-Garcher, Y. Benito, J. Croize, S. Boisset,J. P. Romanet,1 G. Lina, F. Vandenesch. Acute Postoperative Endophthalmitis Caused by Staphylococcus lugdunensis. www.ncbi.nlm.nih.gov