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.