Presumed infectious endophthalmitis following cataract surgery in the UK: a case-control study of risk factors

Aims To study risk factors for presumed infectious endophthalmitis complicating cataract surgery in the United Kingdom. Methods Two hundred and fourteen clinically diagnosed patients with presumed infectious endophthalmitis were compared with 445 control patients throughout the United Kingdom in a prospective case-control study. The cases were identified through the British Ophthalmological Surveillance Unit reporting card system. Control patients undergoing cataract surgery from 13 `control centres' throughout the United Kingdom were selected randomly. Risk factors were identified by univariate and multivariate logistic regression analyses. Pertinent variables relating to the cataract extraction procedure, antimicrobial prophylaxis, ophthalmic and medical history were analysed with regard to postoperative infection. Results Statistically significant risk factors in the multivariate model included inpatient cataract surgery (P = 0.001), surgery in dedicated eye theatres (P < 0.001), consultant grade surgeon (compared to registrar) (P = 0.001), posterior capsule tear during cataract surgery (P = 0.001). The use of face masks by the scrub nurse and surgeon during cataract surgery (P < 0.001) and the administration of subconjunctival antibiotics at the end of surgery (P < 0.001) were protective against postoperative infection. Conclusions In order to minimise the risk of postoperative endophthalmitis we would recommend the wearing of face masks by the surgeon and scrub nurse during cataract surgery and subconjunctival antibiotics at the end of surgery.