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Paul R Healey - One of the best experts on this subject based on the ideXlab platform.

  • efficacy and cost effectiveness of intracameral vancomycin in reducing postoperative Endophthalmitis incidence in australia
    Clinical and Experimental Ophthalmology, 2016
    Co-Authors: Cheryl P Au, Paul R Healey, Andrew White
    Abstract:

    BACKGROUND: Endophthalmitis is a rare but devastating postoperative complication of cataract surgery. We aimed to describe the incidence of acute postoperative Endophthalmitis in an Australian population over a 14-year period. DESIGN: This was a retrospective longitudinal cohort study performed at Westmead Hospital, a major tertiary hospital in Sydney, Australia. PARTICIPANTS: Patients who had acute postoperative Endophthalmitis within 6 weeks of their cataract surgery at Westmead Hospital were included. METHODS: Endophthalmitis cases from 2000 to 2014 were identified from computerized diagnostic coding. These were cross-referenced with the cataract surgery list over this time period. The routine use of intracameral vancomycin at the end of cataract surgery was introduced in Westmead Hospital in 2004. MAIN OUTCOME MEASURES: We quantified the incidence of acute postoperative Endophthalmitis pre and post the routine use of intracameral vancomycin. RESULTS: A total of 14 805 cataract cases were performed at Westmead Hospital from 2000 to 2014. Seventeen cases of Endophthalmitis were within 6 weeks post cataract surgery performed at Westmead Hospital. In the period 2000 to 2003, the incidence of postoperative Endophthalmitis was 0.43% (11/2539). From 2004 to 2014, there was a dramatic decrease in the incidence of postoperative Endophthalmitis to 0.049% (6/12 266, P < 0.0001). CONCLUSIONS: There has been a nine-fold reduction in the rate of acute postoperative Endophthalmitis with the use of intracameral vancomycin in cataract surgery. Post-cataract surgery Endophthalmitis is now a relatively rare cause of Endophthalmitis in this Australian population. Our study supports the routine use of intracameral vancomycin as postoperative Endophthalmitis prophylaxis.

Lise Dannevig - One of the best experts on this subject based on the ideXlab platform.

  • postoperative Endophthalmitis establishment and results of a national registry
    Journal of Cataract and Refractive Surgery, 2003
    Co-Authors: Kjell U Sandvig, Lise Dannevig
    Abstract:

    PURPOSE: To determine the incidence, clinical presentation, etiology, and outcomes of postoperative Endophthalmitis in Norway and to explore the potential of and establish a platform for improving diagnostics, prophylaxis, and treatment of postoperative Endophthalmitis. SETTING: All ophthalmic surgical units and relevant microbiology laboratories in Norway. METHODS: A national registry of cases of postoperative Endophthalmitis was established in 1996. All ophthalmic surgery units in Norway were asked to return forms including preoperative, perioperative, and postoperative data for each case of Endophthalmitis occurring between January 1996 and December 1998 after any intraocular surgery irrespective of the time between the surgery and the onset of Endophthalmitis symptoms. All microbiology laboratories in Norway were asked to return questionnaires regarding their routine handling procedures of eye specimens in cases of Endophthalmitis. RESULTS: From 1996 to 1998, 111 suspected Endophthalmitis cases were reported, all after cataract surgery. Eighty cases were culture positive, 75 with gram-positive bacteria, 4 with gram-negative bacteria, and 1 with Candida albicans. Depending on the definition, the incidence of postoperative Endophthalmitis was between 0.11% and 0.16%. Thirteen percent of cases had "delayed" Endophthalmitis. Twenty-nine percent of eyes had an outcome of permanent amaurosis or light perception visual acuity; 56% (47/84) retained or improved their categorized visual acuity in the affected eye compared to preoperatively. Positive bacterial growth was associated with a worse visual outcome (P =.008). The degree of inflammation when Endophthalmitis was diagnosed and the visual outcomes were worse in cases with growth of streptococci than in cases with growth of staphylococci (P =.009 and P<.001, respectively). The questionnaire to the microbiology laboratories revealed a lack of consensus on how to handle the specimens. CONCLUSIONS: Postoperative Endophthalmitis remains a serious complication of intraocular surgery, although the prognosis depends greatly on the microbe isolated. Common guidelines should be established regarding clinical and microbiological diagnosis and treatment. Further improvement of the registry would make it a suitable platform for evaluating prophylactic treatments.

  • Postoperative Endophthalmitis: establishment and results of a national registry
    Journal of Cataract and Refractive Surgery, 2003
    Co-Authors: Kjell U Sandvig, Lise Dannevig
    Abstract:

    PURPOSE: To determine the incidence, clinical presentation, etiology, and outcomes of postoperative Endophthalmitis in Norway and to explore the potential of and establish a platform for improving diagnostics, prophylaxis, and treatment of postoperative Endophthalmitis. SETTING: All ophthalmic surgical units and relevant microbiology laboratories in Norway. METHODS: A national registry of cases of postoperative Endophthalmitis was established in 1996. All ophthalmic surgery units in Norway were asked to return forms including preoperative, perioperative, and postoperative data for each case of Endophthalmitis occurring between January 1996 and December 1998 after any intraocular surgery irrespective of the time between the surgery and the onset of Endophthalmitis symptoms. All microbiology laboratories in Norway were asked to return questionnaires regarding their routine handling procedures of eye specimens in cases of Endophthalmitis. RESULTS: From 1996 to 1998, 111 suspected Endophthalmitis cases were reported, all after cataract surgery. Eighty cases were culture positive, 75 with gram-positive bacteria, 4 with gram-negative bacteria, and 1 with Candida albicans. Depending on the definition, the incidence of postoperative Endophthalmitis was between 0.11% and 0.16%. Thirteen percent of cases had "delayed" Endophthalmitis. Twenty-nine percent of eyes had an outcome of permanent amaurosis or light perception visual acuity; 56% (47/84) retained or improved their categorized visual acuity in the affected eye compared to preoperatively. Positive bacterial growth was associated with a worse visual outcome (P =.008). The degree of inflammation when Endophthalmitis was diagnosed and the visual outcomes were worse in cases with growth of streptococci than in cases with growth of staphylococci (P =.009 and P

Peter J Mcdonnell - One of the best experts on this subject based on the ideXlab platform.

  • the incidence of Endophthalmitis after cataract surgery among the u s medicare population increased between 1994 and 2001
    Ophthalmology, 2005
    Co-Authors: Emily S West, Ashley Behrens, Peter J Mcdonnell, James M Tielsch, Oliver D Schein
    Abstract:

    Objective To estimate the annual incidence rate of presumed Endophthalmitis after cataract surgery, evaluate any changes in this rate over time, and examine demographic risk factors for Endophthalmitis after cataract surgery. Design Population-based review of Medicare beneficiary claims data. Data Source Medicare 5% sample beneficiary data files for inpatient and outpatient claims from 1994 through 2001 were examined to identify all cataract surgeries and subsequent cases of presumed Endophthalmitis after cataract surgery. Methods All cataract surgery and presumed Endophthalmitis cases after cataract surgery were identified based on claims submitted. The annual rate of presumed Endophthalmitis after cataract surgery was calculated, and demographic risk factors for Endophthalmitis were examined using multivariate models. Main Outcome Measures Incidence rate of Endophthalmitis after cataract surgery and prevalence of demographic risk factors for Endophthalmitis over an 8-year period. Results One thousand twenty-six cases of presumed Endophthalmitis occurred after 477 627 cataract surgeries, yielding an incidence rate of 2.15 per 1000 for this 8-year period. Rates of Endophthalmitis adjusted for age, gender, and race were significantly higher in 1998 to 2001 than in earlier years (relative risk [RR], 1.41; 95% confidence interval [CI], 1.24–1.60). Older age and black race also were associated with increased risk of Endophthalmitis (RR, 1.83; 95% CI, 1.19–2.81; age, ≥90 years, and RR, 1.30; 95% CI, 1.02–1.65, respectively). Conclusions Analysis of Medicare claims data suggests that the incidence of Endophthalmitis after cataract surgery has been increasing, but does not provide an explanation for this occurrence. An increase in the incidence of Endophthalmitis after cataract surgery is of concern, because cataract surgery is the most commonly performed operation in the United States, and the number of cataract surgeries performed annually will likely increase substantially over the coming decades due to the aging of the U.S. population.

  • incidence of acute Endophthalmitis following penetrating keratoplasty a systematic review
    Archives of Ophthalmology, 2005
    Co-Authors: Mehran Taban, Ashley Behrens, Robert L Newcomb, Matthew Y Nobe, Peter J Mcdonnell
    Abstract:

    Objective To determine the incidence of acute Endophthalmitis following penetrating keratoplasty (PK) over time. Methods A systematic review of English-language articles was conducted by performing a broad search of the PubMed database from 1963 through March 2003 using such keywords as penetrating keratoplasty , Endophthalmitis , and postoperative complication . Additional studies were identified from bibliographies of relevant articles and published proceedings. The proportion of eyes with acute Endophthalmitis as a postoperative complication was recorded, and pooled incidence rates were assessed over time. Results From 1870 unique, potentially relevant citations, 66 original studies that addressed Endophthalmitis and met the selection criteria were analyzed. A total of 90 549 PKs were pooled, resulting in an overall estimate of 0.382% post-PK Endophthalmitis, but a change over time was noted. The rate of Endophthalmitis was 0.200% in the 2000-2003 period, 0.453% in the 1990s, 0.376% in the 1980s, and 0.142% during the 1970s. Furthermore, a downward trend in the incidence of Endophthalmitis after 1992 was observed compared with 1991 and earlier. Conclusions This systematic review indicates that the incidence of Endophthalmitis associated with PK has declined during the last decade.

  • acute Endophthalmitis following cataract surgery a systematic review of the literature
    Archives of Ophthalmology, 2005
    Co-Authors: Mehran Taban, Ashley Behrens, Robert L Newcomb, Matthew Y Nobe, Golnaz Saedi, Paula M Sweet, Peter J Mcdonnell
    Abstract:

    Objectives To determine the reported incidence of acute Endophthalmitis following cataract extraction over time and to explore possible contributing factors, such as type of cataract incision. Methods A systematic review of English-language articles was conducted by performing a broad search of PubMed from 1963 through March 2003 using such terms as cataract extraction , Endophthalmitis , and postoperative complication . Additional studies were identified from bibliographies of relevant articles and published proceedings. Surgical approach was recorded, when available. Pooled incidence rates and relative risks of developing Endophthalmitis using different incision techniques were assessed. Results From 4916 unique, potentially relevant citations, 215 studies that addressed Endophthalmitis and met the selection criteria were analyzed. A total of 3 140 650 cataract extractions were pooled resulting in an overall rate of 0.128% of postcataract Endophthalmitis. However, the incidence of acute Endophthalmitis changed over time, with a significant increase since 2000 compared with previous decades (relative risk, 2.44 [95% confidence interval, 2.27-2.61]). The rate of Endophthalmitis was 0.265% in the 2000-2003 period, 0.087% in the 1990s, 0.158% in the 1980s, and 0.327% during the 1970s. Furthermore, an upward trend in rates after 1992 was noted, compared with 1991 and prior. Incision type appeared to significantly influence risk, as Endophthalmitis following clear corneal cataract extraction during the 1992-2003 period was 0.189% compared with 0.074% (relative risk, 2.55 [95% confidence interval, 1.75-3.71]) for scleral incision and 0.062% (relative risk, 3.06 [95% confidence interval, 2.48-3.76]) for limbal incision. Conclusions This systematic review indicates that the incidence of Endophthalmitis associated with cataract extraction has increased over the last decade. This upward trend in Endophthalmitis frequency coincides temporally with the development of sutureless clear corneal incisions.

David Allen - One of the best experts on this subject based on the ideXlab platform.

  • efficacy of intracameral and subconjunctival cefuroxime in preventing Endophthalmitis after cataract surgery
    Journal of Cataract and Refractive Surgery, 2008
    Co-Authors: Patrick Yuwaiman, Stephen J Morgan, Anthony Hildreth, David H W Steel, David Allen
    Abstract:

    Purpose To compare the efficacy of intracameral cefuroxime versus subconjunctival cefuroxime in reducing the rate of Endophthalmitis after cataract surgery. Setting Single-specialty eye hospital, Sunderland, United Kingdom. Methods A retrospective analysis of all presumed infectious Endophthalmitis cases from January 1, 2000, to December 31, 2006 was performed. The rate of presumed infectious Endophthalmitis in patients receiving subconjunctival cefuroxime was compared with those receiving intracameral cefuroxime at the end of surgery. Results This study included 36 743 phacoemulsification cataract procedures. The mean rate of presumed infectious Endophthalmitis was 0.95 per 1000 cases. The incidence of Endophthalmitis was higher in the subconjunctival cefuroxime group than in the intracameral cefuroxime group; the difference was statistically significant with an odds ratio of 3.01 (95% confidence interval, 1.37-6.63). Conclusion Intracameral cefuroxime was a safe alternative to subconjunctival cefuroxime and led to a lower rate of Endophthalmitis.

Kjell U Sandvig - One of the best experts on this subject based on the ideXlab platform.

  • postoperative Endophthalmitis establishment and results of a national registry
    Journal of Cataract and Refractive Surgery, 2003
    Co-Authors: Kjell U Sandvig, Lise Dannevig
    Abstract:

    PURPOSE: To determine the incidence, clinical presentation, etiology, and outcomes of postoperative Endophthalmitis in Norway and to explore the potential of and establish a platform for improving diagnostics, prophylaxis, and treatment of postoperative Endophthalmitis. SETTING: All ophthalmic surgical units and relevant microbiology laboratories in Norway. METHODS: A national registry of cases of postoperative Endophthalmitis was established in 1996. All ophthalmic surgery units in Norway were asked to return forms including preoperative, perioperative, and postoperative data for each case of Endophthalmitis occurring between January 1996 and December 1998 after any intraocular surgery irrespective of the time between the surgery and the onset of Endophthalmitis symptoms. All microbiology laboratories in Norway were asked to return questionnaires regarding their routine handling procedures of eye specimens in cases of Endophthalmitis. RESULTS: From 1996 to 1998, 111 suspected Endophthalmitis cases were reported, all after cataract surgery. Eighty cases were culture positive, 75 with gram-positive bacteria, 4 with gram-negative bacteria, and 1 with Candida albicans. Depending on the definition, the incidence of postoperative Endophthalmitis was between 0.11% and 0.16%. Thirteen percent of cases had "delayed" Endophthalmitis. Twenty-nine percent of eyes had an outcome of permanent amaurosis or light perception visual acuity; 56% (47/84) retained or improved their categorized visual acuity in the affected eye compared to preoperatively. Positive bacterial growth was associated with a worse visual outcome (P =.008). The degree of inflammation when Endophthalmitis was diagnosed and the visual outcomes were worse in cases with growth of streptococci than in cases with growth of staphylococci (P =.009 and P<.001, respectively). The questionnaire to the microbiology laboratories revealed a lack of consensus on how to handle the specimens. CONCLUSIONS: Postoperative Endophthalmitis remains a serious complication of intraocular surgery, although the prognosis depends greatly on the microbe isolated. Common guidelines should be established regarding clinical and microbiological diagnosis and treatment. Further improvement of the registry would make it a suitable platform for evaluating prophylactic treatments.

  • Postoperative Endophthalmitis: establishment and results of a national registry
    Journal of Cataract and Refractive Surgery, 2003
    Co-Authors: Kjell U Sandvig, Lise Dannevig
    Abstract:

    PURPOSE: To determine the incidence, clinical presentation, etiology, and outcomes of postoperative Endophthalmitis in Norway and to explore the potential of and establish a platform for improving diagnostics, prophylaxis, and treatment of postoperative Endophthalmitis. SETTING: All ophthalmic surgical units and relevant microbiology laboratories in Norway. METHODS: A national registry of cases of postoperative Endophthalmitis was established in 1996. All ophthalmic surgery units in Norway were asked to return forms including preoperative, perioperative, and postoperative data for each case of Endophthalmitis occurring between January 1996 and December 1998 after any intraocular surgery irrespective of the time between the surgery and the onset of Endophthalmitis symptoms. All microbiology laboratories in Norway were asked to return questionnaires regarding their routine handling procedures of eye specimens in cases of Endophthalmitis. RESULTS: From 1996 to 1998, 111 suspected Endophthalmitis cases were reported, all after cataract surgery. Eighty cases were culture positive, 75 with gram-positive bacteria, 4 with gram-negative bacteria, and 1 with Candida albicans. Depending on the definition, the incidence of postoperative Endophthalmitis was between 0.11% and 0.16%. Thirteen percent of cases had "delayed" Endophthalmitis. Twenty-nine percent of eyes had an outcome of permanent amaurosis or light perception visual acuity; 56% (47/84) retained or improved their categorized visual acuity in the affected eye compared to preoperatively. Positive bacterial growth was associated with a worse visual outcome (P =.008). The degree of inflammation when Endophthalmitis was diagnosed and the visual outcomes were worse in cases with growth of streptococci than in cases with growth of staphylococci (P =.009 and P