Apart from the classical indication of removing an opaque lens that is compromising vision, extraction of the crystalline lens is gaining increasing importance as a refractive procedure. This literature review which considers the present guidelines of various ophthalmological societies and recently published studies is intended to give an estimate of the incidence of postoperative
endophthalmitis and evidence-based recommendations for its prophylaxis, diagnosis, and
therapy. The incidence of
endophthalmitis after
cataract extraction is reported to be 0.04% to 0.3% in most sizeable studies. Immediate sequential bilateral
cataract surgery is internationally gaining popularity. It remains difficult to estimate whether or not the risk of
endophthalmitis is affected with this approach. A toxic anterior segment syndrome (TASS) needs to be differentiated from postoperative
endophthalmitis. TASS is an acute sterile
inflammation after
cataract surgery. Remnants of
detergents and
antiseptics on the
surgical instruments are supposed to be main triggers. Additionally, the inappropriate preparation of solutions and
antibiotics for intracameral use is considered to be a major cause. A case of TASS was also reported after implantation of an iris-fixated anterior chamber lens in a phakic eye. The
cefuroxime solution that was prophylactically used in the ESCRS study and that is recommended for routine
cataract surgery is not commercially available in Germany as a ready preparation for intraoperative application. Different measures are undertaken in different countries to prevent postoperative
endophthalmitis, whose values are not exactly quantifiable. Antisepsis with
povidone-iodine is still considered to be the component with the best evidence. For management of acute postoperative
endophthalmitis, the systemic application of
antibiotics is recommended in addition to their
intravitreal injection. Few case reports have been published describing an
infection after the implantation of refractive
intraocular lenses (IOLs) in a phakic eye. However, we could not find meaningful information regarding the incidence of
endophthalmitis after implantation of refractive IOLs. Based on the fact that these IOLs are not implanted into the capsular bag but in front of the crystalline lens or into the anterior chamber, and the presumably better anti-microbial immunity of this younger population compared to
cataract patients, one may assume that the
infection rate is lower than after
cataract surgery. Nevertheless, a prospective register to document all
endophthalmitis cases is desirable.