Should some ophthalmic surgery safety protocols be reevaluated?

During the COVID-19 pandemic, one non-Western country implemented new operating room (OR) protocols that are common in many Western practices aimed to reduce the cataract surgical postoperative endophthalmitis (POE) rate. After analyzing pre-and post-POE rates, researchers argue that adopting the new protocol did not reduce the rate of POE and may suggest that some of these common OR protocols are wasteful.

In this retrospective study, outcomes of 85,552 sequential patients undergoing cataract surgery at a single non-Western institution before and after new operating room (OR) protocols were instituted because of COVID-19, were analyzed.

In the first group, 56,551 patients were not gowned, surgical gloves were disinfected but not changed between cases, OR floors were not cleaned between every case, and multiple patients underwent preparation and surgery in the same OR. In the second group, 29,011 patients were gowned, surgical gloves were changed between each case, OR floors and counters were cleaned between patients, and only one patient at a time underwent preparation and surgery in the OR.

Overall, the patients in the first group were older, had better preoperative vision, and had slightly more females compared with the second group.

More eyes in the second group underwent phacoemulsification (P = 0.18).

Postoperative endophthalmitis (POE) occurred in 3 eyes (0.005%) in the first group and 2 eyes (0.006%) in the second group with additional OR protocols. In group 1, 1 eye that underwent phacoemulsification developed POE.

There was no difference in posterior capsule rupture rate between the groups.

Reference
Haripriya A, Ravindran RD, Robin AL, et al. Changing operating room practices: the effect on postoperative endophthalmitis rates following cataract surgery. Br J Ophthalmol. 2022;doi: 10.1136/bjophthalmol-2021-320506. Epub ahead of print. PMID: 35017161.