Outbreak of bacterial endophthalmitis after cataract surgery and lens implantation: lack of direct evidence for exogenous contributing factors

Bacterial endophthalmitis is a rare but devastating disease. The risk of infection after intraocular surgery has declined from about 10% at the turn of the century to about 1% in the 1950s and about 0.35% at present.’ Most reports, however, stress that infection incidence rates are not easily established and not easily interpretable,‘*’ and actual rates may be higher. Intraocular prosthetic lens implantation has become an increasingly popular procedure in the therapy of patients with cataracts. This national trend is reflected by the 100% per year increase of this procedure at our institution in each of the past 3 years. Before May 1984, we had documented two hospital-acquired eye infections after cataract removal and lens implantation in 707 patients (0.3%). The Department of Ophthalmology called our attention to two cases of postimplant endophthalmitis in June 1984. Intensive hospital and postdischarge surveillance identified a total of six cases of bacterial endophthalmitis in 456 patients (1.3%) during the next 5 months. This report summarizes our epidemiologic investigations and steps taken to control this outbreak.