Bilateral simultaneous endophthalmitis after sequential bilateral cataract surgery linked to sterility breach

In a recent case series published in Journal of American Medical Association, three patients experienced bilateral simultaneous postoperative endophthalmitis (BSPOE) after undergoing immediate sequential bilateral cataract surgery (ISBCS) on the same day at a single community-based eye clinic in December 2022. 

BSPOE is a rare but serious complication following cataract surgery that can lead to severe vision impairment. In this study, a 71-year-old woman, an 84-year-old man, and a 79-year-old woman presented with symptoms of endophthalmitis several days after their ISBCS procedures. All three patients had undergone cataract surgeries on the same day at the same clinic.

In response to the infections, five of the six affected eyes required vitrectomy, a surgical procedure to remove the infected vitreous gel from the eye. All infected eyes also received intravitreous injections of antibiotics to combat the infection.

A concerning discovery was that four out of five vitrectomy samples revealed the presence of the same strain of Staphylococcus epidermidis, a bacterium commonly found on the skin and mucous membranes. This uniformity in the microbial culprit strongly suggested a systemic breach of sterility within the clinic during the day of ISBCS.

To rule out the possibility of contamination of surgical viscoelastics, repeated cultures were conducted, confirming that the source of the infection was not related to the materials used in the surgeries.

One patient's eye deteriorated to the point that it had to be eviscerated due to phthisis, a condition where the eye becomes shrunken and non-functional. For another patient, the final visual acuity in the most severely affected eye was recorded at 20/63 Snellen equivalents. However, there was some positive news as the visual acuity in the remaining eyes showed signs of recovery, reaching 20/25 in three eyes of two patients and 20/20 in one eye. The findings underscore the need for comprehensive and ongoing training for surgical staff and stringent oversight to ensure patient safety during cataract surgeries, as well as in other surgical fields where sterility is paramount.

Reference:

Bjerager, J., Leegaard Holm, D.-M., Holm, L., Faber, C., Bate, A., Christakopoulos, C., & Solborg Bjerrum, S. (2023). Outbreak of Bilateral Endophthalmitis After Immediate Sequential Bilateral Cataract Surgery. In JAMA Ophthalmology. American Medical Association (AMA). https://doi.org/10.1001/jamaophthalmol.2023.4637