Incidence of post-cataract surgery endophthalmitis: a chronological review and intercontinental comparison

Purpose: This review aimed to investigate the global incidence of postoperative endophthalmitis (POE) after cataract surgery over the last three decades, with a particular focus on the use of prophylactic intracameral antibiotics. Study design: Literature review. Methods: A literature search was performed in PubMed and Scopus. Data was collected from included studies and analyzed in IBM SPSS v27. Results: A total of 63 studies from 20 regions were included. The use of prophylactic intracameral antibiotics significantly reduced POE incidence. The baseline POE incidence in studies that involved intracameral prophylaxis tended to be high. A downward linear trend in POE incidence was observed in studies that did not involve intracameral antibiotic prophylaxis. Interestingly, a study in Japan reported the use of intracameral antibiotic prophylaxis in only 10.4% of cataract surgeries with an overall POE incidence of 0.025%, which is comparable to countries that use intracameral prophylaxis routinely. Within studies from Australia, China, Europe, India, Singapore and United States, Australia had the highest POE incidence with and without intracameral prophylaxis, while China had the lowest POE incidences. Conclusion: Intracameral antibiotics are an effective prophylaxis against POE. However, the incidence of POE is decreasing worldwide even without intracameral prophylaxis. The benefits of intracameral antibiotics should be weighed against its risks prior to its implementation as routine prophylaxis protocol for cataract surgery.