RESUMO
AIM: To determine the risk factors for acute endophthalmitis after cataract extraction in a tertiary care centre in India. METHODS: We performed a nested case control study within a retrospective cohort. The surgical records of all patients with clinically diagnosed endophthalmitis within one month after cataract surgery, performed between January 2006 and December 2009, were reviewed. These were compared with randomly selected age and gender-matched controls, from patients having routine cataract surgery within ±1wk of the endophthalmitis case. Univariable and multivariable analysis were performed to identify risk factors for endophthalmitis. RESULTS: Of the total 33 856 cataract surgeries performed during this period, there were 57 cases of postoperative acute endophthalmitis that met our study criteria. Thus, the overall incidence of endophthalmitis in our cohort was 1.6 per 1000 cataract extractions performed. Mean age of cases was 55.9y (SD: 10.9y) and for controls was 55.6y (SD: 9.8y). Thirty-five cases (61.4%) and 133 controls (59.6%) were males. Median time of onset of endophthalmitis was 4d (IQR 2-9d; range: 1-30d). Thirty-nine cases (68.4%) presented within 7d and 27 cases (47.4%) were culture positive. Two hundred and twenty-three age and gender matched controls were selected. In multivariate analysis, endophthalmitis was associated with posterior capsular rupture (PCR) during surgery (OR 6.98, 95%CI: 2.22-21.98), phacoemulsification via scleral incision with a foldable intraocular lens (IOL) implantation (OR 3.02, 95%CI: 1.13-8.04) and ocular co-morbidity (OR 2.32, 95%CI: 1.11-4.87). CONCLUSION: PCR, presence of ocular co-morbidity, and phacoemulsification via scleral incision with foldable-IOL were found to be independent risk factors for acute endophthalmitis.
RESUMO
PURPOSE: To compare the diagnostic capability of the Heidelberg Retina Tomograph (HRT) 2 and 3 (Heidelberg Engineering, GmBH, Dossenheim, Germany) for glaucoma in an Indian population. DESIGN: Evaluation of a diagnostic technology. PARTICIPANTS: Ninety-eight glaucoma subjects and 79 normal controls. METHODS: All participants underwent imaging with HRT2. Heidelberg Retina Tomograph 2 examinations were exported to HRT3 software. The stereometric parameters of HRT2 and HRT3 were compared. The diagnostic capability of Moorfields Regression Analysis (MRA) in the HRT2, HRT3 with and without ethnicity correction, and Glaucoma Probability Score (GPS) of HRT3 were compared. Analysis was done with the borderline results of MRA and GPS considered as normal to derive the most specific criteria and as abnormal to derive the least specific criteria. MAIN OUTCOME MEASURES: Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). RESULTS: On standard automated perimetry (SAP), the mean deviation (mean+/-standard deviation) of the glaucoma and normal groups were -7.3+/-6.7 dB and -0.4+/-1.1 dB, respectively (P<0.001). The AUC for the individual stereometric parameters of HRT2 were similar to that of HRT3. The sensitivity and specificity (most specific criteria) were 56.1% and 96.2%, respectively, for MRA of HRT2 and 56.1% and 91.1%, respectively, for MRA of HRT3. The sensitivity and specificity (least specific criteria) were 88.8% and 88.6%, respectively, for MRA of HRT2 and 70.4% and 81%, respectively, for MRA of HRT3. By using the Indian specific normative database of HRT3, the sensitivity and specificity were 37.8% and 97.5%, respectively, for the most specific criteria, and 55.1% and 89.9%, respectively, for the least specific criteria. Sensitivity and specificity of GPS were 86.7% and 68.3%, respectively, for the most specific criteria, and 93.9% and 39.2%, respectively, for the least specific criteria. CONCLUSIONS: In this cohort, the diagnostic capability of HRT2 MRA was similar to that of HRT3 MRA; ethnicity correction did not improve results; GPS was more sensitive but less specific than MRA in diagnosing glaucoma.
