Endophthalmitis After Cataract Surgery: An Update on Recent Advances

Travis J. Peck; Samir N. Patel; Allen C. Ho


Curr Opin Ophthalmol. 2021;32(1):62-68. 

In This Article

Abstract and Introduction


Purpose of Review: Prevention and management of postcataract endophthalmitis remain quite relevant for anterior segment and vitreoretinal surgeons. Although the Endophthalmitis Vitrectomy Study, published in 1996, remains the only level 1 evidence for the management of postcataract endophthalmitis, recent advances have resulted in an evolution of practice patterns. The aim of this review is to summarize the literature regarding postcataract endophthalmitis with a focus on the last 18 months.

Recent Findings: The IRIS registry indicates the rates of endophthalmitis are decreasing in the United States, and the outcomes appear to be improving. Intracameral moxifloxacin has become more widely accepted and intracameral vancomycin has been shown to be associated with retinal vasculitis. The role of systemic antibiotics and vitrectomy is unclear and practice patterns vary widely.

Summary: Although practice patterns vary, prevention and treatment of endophthalmitis after cataract surgery continues to improve. More uniform guidelines regarding surgical and medical therapy are necessary but the standard of prompt referral to a vitreoretinal specialist for immediate intravitreal antibiotics remains the most important intervention in the management of postcataract endophthalmitis.


Cataract surgery is one of the most commonly performed surgeries in all of medicine. Patients and surgeons have come to expect excellent results with a great deal of attention focused on minimizing potential adverse outcomes. One of the most feared complications is postoperative endophthalmitis, which may result in significant irreversible vision loss. Prevention via meticulous sterile and surgical technique, preoperative povidone iodine, and intracameral antibiotics has effectively reduced rates of endophthalmitis over the past two decades. There is still debate, however, regarding the management of endophthalmitis. The Endophthalmitis Vitrectomy Study (EVS), which enrolled patients from 1990 to 1994, provides the only level 1 evidence on this subject. As a result of developments in technology, pharmacology, and technique since that time, the management of endophthalmitis has evolved significantly. In this review, we discuss recent developments in the prevention, diagnosis, and treatment of postcataract endophthalmitis with special attention to literature published from 2019 to 2020.