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Lee, Moon, Ji, and Yoon: Treatment Outcome of Wbund Infection after Cataract Surgery and Risk Factors of Treatment Failure
Original Article

J Korean Ophthalmol Soc 2018;59(4):319-324.

Published online: 7 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.4.319

Treatment Outcome of Wbund Infection after Cataract Surgery and Risk Factors of Treatment Failure

Dong Kyu Lee, MD, Hyun Sik Moon, MD, Yong Sok Ji, MD, PhD, Kyung-Chul Yoon, MD, PhD

Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea

Address reprint requests to Kyung-Chul Yoon, MD, PhD Department of Ophthalmology, Chonnam National University Hospital, #42 Jebong-ro, Dong-gu, Gwangju 61469, Korea Tel: 82-62-220-6753, Fax: 82-62-227-1642, E-mail: kcyoon@jnu.ac.kr

Received 23 November 2017       Revised 3 January 2018       Accepted 28 March 2018

Copyright © 2018 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate factors affecting wound infection after cataract surgery, and treatment outcomes.

Methods

In this retrospective study, we included 20 patients (20 eyes) who experienced wound infection after cataract surgery (phacoemulsification with intraocular lens implantation) between January 2005 and January 2017. Only those who yielded positive microbial smears were selected. All patients were assigned to a “treatment success group” (remission of infection) or a “treatment failure group” (aggravation of infection or a need for surgical intervention to treat an infectious complication). The demographic, clinical and microbiological features of the two groups were compared and binary logistic regression analyses were performed to identify factors affecting treatment failure.

Results

Wound infection developed at 12.25 ± 20.21 days (range 5 to 45 days) after cataract surgery. Sixteen patients developed bacterial and four developed fungal keratitis. Of the 20 patients, 13 (65.0%) were treated successfully and 7 (35.0%) were not. In univariate analyses, diabetes (p = 0.035), incisional suturing (p = 0.038), combined endophthalmitis (p = 0.001), and fungal infection (p = 0.021) were associated with treatment failure. Multivariate analyses showed that combined endophthalmitis (p = 0.001) and fungal infection (p = 0.044) were significant risk factors for treatment failure.

Conclusions

Cataract wound infection is rare but constitutes a serious complication. Combined endophthalmitis and fungal infection are associated with poor treatment outcomes.

Keywords: Cataract surgery, Complication, Infection

REFERENCES

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Figure 1.
The frequency of wound infection after cataract surgery by year. It shows distribution of occurence in total 20 patients.
jkos-59-319f1.tif
Table 1.
Characteristics of patients with wound infection after cataract surgery
Variables Total patients (n = 20) Treatment success group (n = 13) Treatment failure group (n = 7) p-value
Age (years) 60.57 ± 12.14 58.74 ± 14.74 62.47 ± 13.66 0.641
Sex (male/female) Underlying disease 11 (55.0)/9 (45.0) 7 (53.85)/6 (46.15) 4 (57.14)/3 (42.86) 0.954
 Diabetes 5 (40.0) 1 (7.69) 4 (30.77) 0.025
 Hyperetension 10 (50.0) 6(46.15) 4 (30.77) 0.341
 Chronic kidney disease 3 (15.0) 2 (15.38) 1 (7.69) 0.145
 Immunocompromised state 2 (10.0) 1 (7.69) 1 (7.69) 0.214
Preoperative conditions
 Dry eye disease 7 (35.0) 4 (30.77) 3 (23.08) 0.214
 Meibomian gland dysfunction 6 (30.0) 4 (30.77) 2 (28.57) 0.423
 Nasolacrimal duct obstruction 4 (20.0) 2 (15.38) 2 (28.57) 0.316
History of ocular surgery
 Pterygium operation 7 (35.0) 4 (30.77) 3 (23.08) 0.214
 Refractive surgery 6 (30.0) 3 (23.07) 3 (23.08) 0.214
 Vitrectomy 4 (20.0) 2 (15.38) 1 (7.69) 0.474
Onset of symptoms/signs after surgery (days) 12.25 ± 20.21 (5–45) 14.47 ± 12.24 11.62 ± 9.24 0.475
Type of incision (corneal/scleral) 17 (85.0)/3 (15.0) 11/2 6/1 0.571
Incision location (temporal/superior) 12 (60.0)/8 (40.0) 8/5 4/3 0.743
Suture (yes/no) 6 (30.0)/14 (70.0) 2/11 4/3 0.034
Size of infiltration (mm2) 7.21 ± 9.41 (3–45) 3.16 ± 1.47 4.15 ± 1.13 0.130
Hypopyon (present/absent) 8 (40.0)/12 (60.0) 5/8 3/4 0.114
Combined endophthalmitis (present/absent) 6 (30.0)/14 (70.0) 3/10 3/4 0.001
Topical antibiotics use (yes/no) 4 (20.0)/16 (80.0) 3/10 1/6 0.064
Topical steroid use (yes/no) 7 (35.0)/13 (65.0) 4/9 3/4 0.036
Systemic steroid use (yes/no) 8 (40.0)/12 (60.0) 5/8 3/5 0.057
Microbiology results (bacteria/fungus) (bacteria:fungus) 16/4 12/1 4/3 0.029

Values are presented as mean ± standard deviation (range) or n (%) unless otherwise indicated.

Table 2.
Results of staining and culture in patients with wound infection after cataract surgery
Pathogens No. of cases Year of occurence
Bacteria 16
 Staphylococcus epidermidis 4 (25.0) 2008, 2015 (2 cases), 2016
 Staphylococcus aureus 3 (18.8) 2012, 2013, 2014
 Streptococcus pneumonia 2 (12.5) 2005, 2012
 Streptococcus viridans 2 (12.5) 2005, 2012
 Enterobacter cloaca 1 (6.3) 2012
 Klebsiella ornithinolytica 1 (6.3) 2007
 Pseudomonas aeruginosa 1 (6.3) 2011
 No growth 2 (12.5) 2006, 2011
Fungus 4
 Aspergillus species 2 (50.0) 2006, 2010
 Candida albicans 1 (25.5) 2011
 No growth 1 (25.5) 2011

Values are presented as n (%) unless otherwise indicated.

Table 3.
Mean visual acuity at the time of presentation and final follow-up in the treatment success and treatment failure groups in patients with wound infection after cataract surgery
Variables Treatment success group (n = 13) Treatment failure group (n = 7) p-value
Baseline (logMAR) 1.88 ± 0.92 2.12 ± 0.84 0.065
Final follow-up (logMAR) (bacteria:fungus) 0.61 ± 0.36 1.70 ± 0.95 0.022

Values are presented as mean ± SD unless otherwise indicated.

Table 4.
Risk factors for treatment failure of wound infection after cataract surgery
Variable Univariate analysis
 Multivariate analysis
OR (95% CI) p-value OR (95% CI) p-value
Diabetes (yes/no) 3.24 (1.01–4.74) 0.035 2.98 (1.30–6.19) 0.246
Suture (yes/no) 5.67 (2.47–7.87) 0.038 4.91 (1.78–9.56) 0.263
Combined endophthalmitis (yes/no) 12.56 (1.27–45.67) 0.001 12.47 (1.15–45.89) 0.001
Topical steroid use (yes/no) 7.78 (0.47–68.14) 0.057 6.11 (0.55–57.87) 0.464
Microbiology (fungus/bacteria) 5.21 (0.97–21.14) 0.021 5.17 (0.99–21.54) 0.044

OR = odds ratio; CI = confidence interval.

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