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Original ArticleOpen Access
A Report of an Outbreak of Postoperative Endophthalmitis
Swaddiwudhipong W 
,
Linlawan P ,
Prasantong R ,
Kitphati R ,
Wongwatcharapaiboon P
,
Linlawan P ,
Prasantong R ,
Kitphati R ,
Wongwatcharapaiboon P PlY A LINLAWAN, M.D.**,
ROONGRUENG KITPHA Tl, M.D.**,
We report an outbreak of endophthalmitis following cataract extraction or secondary
intraocular lens (IOL) implantation in a 400-bed general hospital in northern Thailand. From
December 1997 to September 1998, of 329 patients who had undergone cataract extraction or
secondary IOL implantation in the hospital, 31 (9.4%) developed postoperative endophthalmitis.
The interval between the operation and the clinical diagnosis of endophthalmitis ranged from 5 to
74 days with a median of 15 days. Of the 31 cases of endophthalmitis, 18 occurred in phacoemul-
sification (PE) with IOL,
11
in extracapsular cataract extraction (ECCE) with IOL, and 2 in
secondary IOL implantation. Patients who had undergone PE with IOL had a significantly higher
rate (12.4%) than those of ECCE with IOL (6.3%). The infection rates also increased with the
order of the operations within each operation period (morning or afternoon); later operations
were at higher risk. Our findings detected defects in sterilization for the surgeries including
possible inadequacy in the autoclave sterilization of surgical instruments, insufficient exposure
time with 2 per cent activated glutaraldehyde solution (about 15-30 minutes) for sterilizing some
surgical instruments, and the use of multiple-dose intraocular irrigating solution. This outbreak of
endophthalmitis emphasizes the necessity to monitor regularly the practice of sterilization/
disinfection in hospitals for prevention and control of nosocomial infections.
Key word
: Endophthalmitis, Nosocomial Outbreak, Sterilization
ROONGRUENG KITPHA Tl, M.D.**,
We report an outbreak of endophthalmitis following cataract extraction or secondary
intraocular lens (IOL) implantation in a 400-bed general hospital in northern Thailand. From
December 1997 to September 1998, of 329 patients who had undergone cataract extraction or
secondary IOL implantation in the hospital, 31 (9.4%) developed postoperative endophthalmitis.
The interval between the operation and the clinical diagnosis of endophthalmitis ranged from 5 to
74 days with a median of 15 days. Of the 31 cases of endophthalmitis, 18 occurred in phacoemul-
sification (PE) with IOL,
11
in extracapsular cataract extraction (ECCE) with IOL, and 2 in
secondary IOL implantation. Patients who had undergone PE with IOL had a significantly higher
rate (12.4%) than those of ECCE with IOL (6.3%). The infection rates also increased with the
order of the operations within each operation period (morning or afternoon); later operations
were at higher risk. Our findings detected defects in sterilization for the surgeries including
possible inadequacy in the autoclave sterilization of surgical instruments, insufficient exposure
time with 2 per cent activated glutaraldehyde solution (about 15-30 minutes) for sterilizing some
surgical instruments, and the use of multiple-dose intraocular irrigating solution. This outbreak of
endophthalmitis emphasizes the necessity to monitor regularly the practice of sterilization/
disinfection in hospitals for prevention and control of nosocomial infections.
Key word
: Endophthalmitis, Nosocomial Outbreak, Sterilization
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