Factors for the development of postoperative endophthalmitis include immunosuppression, most commonly diabetes. “Eyelid or surface disease is easy to pick up,” said Dr. Jumper. “The altered flora of things like a prosthesis or a contact lens, or even a punctal plug can have an impact on what flora are on the eye and what might be getting into the eye with an injection.
“Surgeon factors include the use of providone iodine,” he added. “The use of lidocaine jelly before the providone preparation can increase the risk.”
Vitreous lost during cataract surgery increases the risk of infection by four- or five-fold. “A patient who has a wound leak, especially if they don’t get patched at the time of surgery, can have an increased risk,” Dr. Jumpers said “Inferior wound location and silicone intraocular lens have been implicated as an increased risk factor for developing infection.”
One recent study showed that anti-vascular endothelial growth factor (anti-VEGF) injections increase the risk of endophthalmitis (delayed or acute) two- or three-fold. “It’s something I would consider when talking about antibiotics prophylaxis with a patient having cataract surgery,” said Dr. Jumper.