The occurrence rate of acute-onset postoperative endophthalmitis after cataract surgery in Chinese small- and medium-scale departments of ophthalmology.

Endophthalmitis can be a devastating complication after cataract surgery. Therefore, this study sought to better understand the occurrence rate of acute-onset postoperative endophthalmitis after cataract surgery in Chinese small and medium-scale departments of ophthalmology, as well as identify its risk factors and assess the treatment options. This investigation revealed 52 postoperative endophthalmitis cases in 46,185 operations at 30 hospitals from 2011 to 2013, at an occurrence rate of 0.11%. A small cataract surgery volume of less than 500 cases per year (OR 2.21; p = 0.006), the absence of 0.5% povidone iodine (PVP-I) irrigation (OR 1.73; p = 0.046), and intraoperative posterior capsular rupture (PCR) with vitreous loss (OR 4.40; p = 0.034) showed statistically significant associations with endophthalmitis in the multivariate analysis. The rate of culture positivity was 44.2%, with Staphylococcus epidermidis being the most common organism isolated in China. More than 40% of the endophthalmitis cases were treated with a nonstandard antibiotics regimen, and only 32.7% of these had a visual acuity of better than 20/40. We concluded that the occurrence rate of acute-onset endophthalmitis following cataract surgery in Chinese small and medium-scale departments of ophthalmology lags behind the level of developed countries, as well as Chinese top eye centers. Overall, the use of 0.5% PVP-I irrigation seemed to be an effective measure to reduce the risk of the development of postoperative endophthalmitis.

Comparative outcomes of femtosecond laser-assisted cataract surgery and manual phacoemusification: a six-month follow-up.

BACKGROUND: To explore efficacy and safety outcomes in patients undergoing femtosecond laser-assisted cataract surgery (FLACS) versus manual phacoemulsification cataract surgery (PCS). DESIGN: Prospective consecutive nonrandomized comparative cohort study. PARTICIPANTS: A total of 124 eyes from 106 patients (70 in FLACS and 54 in PCS). METHODS: Comparison of FLACS with PCS over 6 months. MAIN OUTCOME MEASURES: Macular central subfield thickness (CST), cube volume (CV), cube average thickness (CAT), endothelial cell density (ECD), central corneal thickness (CCT) and photon count value (PCV). RESULTS: CST, CV and CAT increased postoperatively, which did not return to preoperative levels by 6 months. The values were similar between groups throughout the follow-up, and comparison of changes from baseline also showed no significant difference. Preoperative ECD showed significant difference, which decreased postoperatively and remained stable during follow-up, being lowest at 1 month. FLACS had greater endothelial cell loss than PCS, which was not significant. CCT in both groups increased, reaching maximum on day one and tended to decrease thereafter. No significant differences were found regarding postoperative values and the mean increase. In both groups, mean PCV increased from preoperatively to day one, week one and month one. Flare values in FLACS were lower than PCS, reaching statistical significance at 6 months (P = 0.001). However, the differences in changes of PCV were not significantly different at any visit. CONCLUSIONS: Both FLACS and PCS achieved similar safety and efficacy outcomes for performing cataract surgery. Flare values in eyes with FLACS were lower than those with PCS at 6 months postoperatively.

Evaluation of dry eye after femtosecond laser-assisted cataract surgery.

PURPOSE: To compare dry-eye signs and symptoms after femtosecond laser-assisted cataract surgery and conventional phacoemulsification. SETTING: Eye Center of the 2nd Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China. DESIGN: Prospective consecutive nonrandomized comparative cohort study. METHODS: Consecutive patients who had femtosecond laser-assisted or phacoemulsification cataract surgery were assessed. Dry-eye markers including the ocular surface disease index (OSDI) and subjective symptom questionnaire, tear-film assessment using Keratograph 4 corneal topography, Schirmer testing I, and fluorescein staining were sequentially evaluated preoperatively and postoperatively at 1 day, 1 week, and 1 month. RESULTS: The study recruited 137 eyes (137 patients) with similar baseline characteristics. Most patients developed dry eye postoperatively. Subjective symptoms and fluorescein staining scores elevated from baseline, tear breakup time and Schirmer testing I values decreased postoperatively, which peaked at 1 week and did not return to baseline within 1 month. There were no significant differences between the 2 groups (all P > .05) except for a higher fluorescein staining score in the femtosecond group at 1 day (P = .001), 1 week (P = .047), and 1 month (P = .025). OSDI score and subjective symptoms were greater in the laser group at 1 week (P = .014 and P = .016, respectively). Subgroup analysis showed obvious worsening by fluorescein staining at 1 day (P = .016) and 1 month (P = .009) in preoperative dry-eye patients. CONCLUSIONS: Both methods worsened dry eye postoperatively. Femtosecond-assisted surgery had a higher risk for staining and dry-eye symptoms. Patients with preexisting dry eye who had femtosecond-assisted surgery had more severe ocular surface staining than those having conventional surgery. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.