Acute postoperative endophthalmitis in cataract surgery, while rare, occurs despite efforts at prevention. Risk factors include host-related characteristics and technique-related aspects. The ocular surface plays a pivotal role, with external microbial flora serving as a pervasive potential source of organisms for infection. Innate natural defence mechanisms are capable of protecting against infection, despite evidence of microbial contamination, with organisms recovered from aqueous humour even in uncomplicated cataract surgeries. With acute endophthalmitis after cataract surgery, coagulase-negative Staphylococci species are the most commonly recovered organisms, followed by other Gram-positive organisms and, less frequently, Gram-negative organisms. Strategies to prevent infection aim to limit organisms entering the eye by reducing organisms on the ocular surface, preventing intraoperative intraocular bacterial contamination and preventing postoperative bacterial contamination with watertight wound closure. Secondary strategies target the eradication of organisms that (despite all precautions) might have entered the eye, including intracameral antibiotic administration. Topical ophthalmic antisepsis with administration of povidone-iodine reduces the clinical occurrence of endophthalmitis with cataract procedures. Evidence demonstrates similar low rates of postoperative endophthalmitis after cataract surgery using standardised preoperative preparation alone, with or without intracameral antibiotic administration, in routine, uncomplicated cases. Stratification of risk guides possible adjunctive intracameral antibiotic administration in addition to standardised prevention practices, with individuals at higher risk, including those undergoing same-day bilateral surgery or with complicated and combined procedures.
Kuo et al. (Thu,) studied this question.