Bacterial endophthalmitis following sutureless cataract surgery

Area of Science:

• Ophthalmology
• Infectious Diseases
• Surgical Pathology

Background:

• Cataract surgery, specifically phacoemulsification with intraocular lens implantation and sutureless wound closure, is a common procedure.
• Endophthalmitis, an inflammation of the eye's interior, is a serious complication that can lead to vision loss.
• Group G Streptococcus is a potential pathogen in postoperative ocular infections.

Observation:

• A case of endophthalmitis was identified following phacoemulsification with intraocular lens implantation and sutureless wound closure.
• Surgical video review revealed potential breaches in sterile technique, including inadequate draping and excessive instrument manipulation.
• The wound's water tightness was tested using a viscoelastic substance, which may have introduced contaminants.

Findings:

• Pathologic examination of the enucleated globe showed intense suppurative reaction in the anterior chamber.
• The surgical wound was found to be open and filled with fibrinopurulent granulation tissue.
• Microscopic analysis confirmed the presence of Group G Streptococcus, indicating a bacterial infection.

Implications:

• This case highlights the risk of endophthalmitis associated with specific surgical techniques and wound closure methods.
• Adherence to stringent sterile protocols and optimized surgical practices is crucial to prevent postoperative infections.
• The findings underscore the importance of meticulous surgical technique and proper wound management in preventing severe ocular complications.