Postoperative endophthalmitis is a serious complication that can occur after cataract surgery. It is caused by the invasion of microbial flora, bacteria, or fungi from the appendages and environment during the procedure. To reduce the risk of postoperative endophthalmitis, it is important to evaluate patients for any possible risk factors and consider intraoperative risk management and prophylaxis protocols. Additionally, early follow-up after cataract surgery is strongly recommended to detect any signs of endophthalmitis and ensure that the patient complies with post-surgical medications and precautions.
One of the most effective ways to prevent postoperative endophthalmitis is to place a patch after surgery as a protective measure and keep it for approximately four hours. This helps to keep the wound sealed and reduce the possibility of endophthalmitis. Intracameral injection of cefazolin bolus (1 mg in 0.1 ml of solution) and also of 1 mg intracameral cefuroxime at the end of cataract surgery have been shown to reduce the rate of postoperative endophthalmitis without toxic effects on the cornea or retina. Prophylactic subconjunctival antibiotic injections at the end of cataract surgery have also been found to reduce the incidence of postoperative endophthalmitis.
It is important to take great care when performing cataract surgery to avoid posterior capsule rupture and anterior vitrectomy, as these are risk factors for acute endophthalmitis. The ESCRS study on the prophylaxis of endophthalmitis after cataract surgery evaluated the effects of an intracameral injection of 1 mg of cefuroxime at the end of surgery and an intensive pulsed perioperative topical application of levofloxacin in a 2 x 2 factorial design. To summarize, postoperative endophthalmitis can be prevented by evaluating patients for any possible risk factors, considering intraoperative risk management and prophylaxis protocols, placing a patch after surgery as a protective measure, using intracameral injections of antibiotics, and performing early follow-up after cataract surgery. Taking these steps can help reduce the risk of postoperative endophthalmitis and ensure that any signs are detected and treated immediately.