Endophthalmitis Then and Now

More than a century of innovation has transformed how endophthalmitis is prevented, diagnosed, and treated.

By: Landon J. Rohowetz, MD, Patrick C. Staropoli, MD, Stephen G. Schwartz, MD, MBA, Christopher Leffler, MD, MPH, Harry W. Flynn Jr., MD

Retinal Physician May 1, 2025 Vol 22, Issue May 2025 Page(s): 8-12

Clinical Report: Endophthalmitis Then and Now

Overview

This report reviews the evolution of endophthalmitis prevention, diagnosis, and treatment over the past century. It highlights the significant decline in postoperative endophthalmitis rates, particularly following cataract surgery, due to advancements in surgical techniques and prophylactic measures.

Background

Endophthalmitis is a severe intraocular infection that can lead to significant vision loss, making its prevention and management critical in ophthalmic surgery. The condition can arise from various etiologies, including postoperative complications, and has historically posed a challenge in clinical practice. Understanding the advancements in its management is essential for improving patient outcomes.

Data Highlights

Current reported rates of endophthalmitis following cataract surgery range from 0.02% to 0.2%, with a notable decline from about 1% in the 1960s to 0.068% in recent years.

Key Findings

Acute-onset postoperative endophthalmitis typically presents with pain, decreased vision, and intraocular inflammation.
The introduction of antisepsis in the 1870s significantly reduced endophthalmitis rates from 6.6% to 1.5%.
Prophylactic topical and subconjunctival antibiotics have contributed to a decline in endophthalmitis rates from 1.16% to 0.21% between 1945 and 1960.
Intracameral cefuroxime has shown a 5-fold reduction in endophthalmitis rates compared to controls, although its adoption varies.
Despite advancements, endophthalmitis remains a risk and cannot be entirely prevented, emphasizing the need for ongoing vigilance and improved practices.

Clinical Implications

Healthcare professionals should implement evidence-based practices, including the use of intracameral antibiotics and meticulous antisepsis, to minimize the risk of endophthalmitis during cataract surgery. Continuous education on the evolving guidelines and treatment protocols is essential for optimizing patient care.

Conclusion

The evolution of endophthalmitis management reflects significant advancements in surgical practices and prophylactic measures. Ongoing research and adherence to updated guidelines are crucial for further reducing the incidence of this serious complication.

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Retinal Physician