To investigate the causative organisms, the clinical characteristics, visual outcomes and the incidence of acute endophthalmitis after cataract surgery.

In this retrospective study, a charts review was performed for patients treated in a tertiary referral center for acute endophthalmitis after cataract surgery from January 2005 to December 2009. The cohort comprised 70 patients (8 of whom underwent cataract surgery at our center, and 62 who were referred). Demographic, clinical, and laboratory data were analyzed. The primary outcome measure was final visual acuity. P<0.05 indicated statistical significance.

During the study period, 7737 cataract surgeries were performed in this center. Eight (0.10%) of 7737 eyes developed acute postoperative endophthalmitis. Subgroup analysis indicated extracapsular cataract extraction was associated with a 4- fold higher risk of endophthalmitis compared with phacoemulsification. The better initial visual acuity (VA) (≥ hand motion) (P<0.001) and negative cultures (P=0.021) were independently associated with a more favorable visual outcome. Patients with relative afferent papillary defect (RAPD) were associated with lower initial VA (P<0.001) and worse visual outcome (P=0.001). Positive microbial cultures were found for 33 (42.9%) cases. Staphylococcus aureus was the most common organism isolated.The “gram-positive coagulase-negative” and “no growth” groups had the best visual outcome.

The visual outcome after endophthalmitis was generally poor and only one eighth of the eyes achieved a final acuity of ≥20/200.Therefore, better treatment strategies warranted. Immediate treatment is essential and the role of primary vitrectomy requires further investigation.