Comparison of Cataract Surgery Endophthalmitis Rates in Operating Rooms With and Without Laminar Air Flow and High-Efficiency Particulate Air Filters
Abstract
PURPOSE: To determine if use of laminar air flow (LAF) and high-efficiency particulate air (HEPA) filtration during cataract surgery reduces the rate of postoperative endophthalmitis (POE).
DESIGN: Retrospective, clinical cohort study.
SUBJECTS: A total of 452 770 cataract surgeries performed at 14 hospitals within the Aravind Eye Care System in India during the 2023 calendar year.
METHODS: A retrospective analysis of the study population was conducted. Identical surgical and infection prophylaxis protocols were used at every surgical facility, including periocular povidone-iodine and intracameral moxifloxacin. POE rates were determined for each type of air handling unit (AHU) used during cataract surgery: LAF with HEPA filter (group 1), central air conditioning (AC) with HEPA filter (group 2), central AC without HEPA filter (group 3), or split-type AC without HEPA filter (group 4). Additional subanalyses were performed based on the cataract surgical method (phacoemulsification vs manual small-incision cataract surgery) and patients' socioeconomic status (paying vs nonpaying).
MAIN OUTCOME MEASURES: Rates of postoperative endophthalmitis.
RESULTS: Of 452 770 cataract surgeries performed at the Aravind Eye Care System in 2023, 74 cases of POE (0.016%) were diagnosed. The POE rates for each AHU type were determined to be 0.013% for group 1 (15 cases in 116 981 eyes), 0.016% for group 2 (21 cases in 128 089 eyes), 0.017% for group 3 (16 cases in 93 074 eyes), and 0.019% for…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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