Controversies, consensuses, and guidelines on preventing, diagnosing and managing acute-onset bacterial endophthalmitis after cataract surgery by the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO), the Asia-Pacific Vitreo-retina Society (APVRS), and the Asia-Pacific Society of Ocular Inflammation and Infection (APSOII)
Sharma, Namrata Bari, Aafreen Rao, Srinivas K Agrawal, Rupesh Allen, Penelope J Buchan, John C Chang, Andrew Chang, David F Chee, Soon-Phaik Chen, Weirong
Sharma, Namrata
Bari, Aafreen
Rao, Srinivas K
Agrawal, Rupesh
Allen, Penelope J
Buchan, John C
Chang, Andrew
Chang, David F
Chee, Soon-Phaik
Chen, Weirong
Affiliation
Sandwell and West Birmingham NHS Trust; All India Institute of Medical Sciences; Darshan Eye Care & Surgical Centre; Tan Tock Seng Hospital; et al.
Other Contributors
Publication date
2025-08-16
Subject
Collections
Research Projects
Organizational Units
Journal Issue
Abstract
Background: Postcataract surgery endophthalmitis is a serious but largely preventable clinical entity. The implementation of uniform preoperative, intraoperative, and postoperative protocols is essential to reduce its incidence. Methods: In light of emerging evidence and considerable variability in clinical practices, a panel of international experts from the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO), the Asia-Pacific Vitreo-retina Society (APVRS), and the Asia-Pacific Society of Ocular Inflammation and Infection (APSOII) convened to develop evidence-based guidelines addressing all phases of cataract surgery. This consensus manuscript is the product of a systematic review of the current literature, informed by the collective experience and expertise of the panel members. The panel engaged in structured discussions, critical evaluation of clinical data, and formal voting to establish agreement across three key domains: (1) preoperative and intraoperative prophylactic strategies, (2) diagnostic approaches for early postoperative acute bacterial endophthalmitis, and (3) standardized management protocols. Voting on each proposed statement was conducted using a 5-point Likert scale (strongly agree, agree, neutral, disagree, strongly disagree). Consensus was defined as ≥75% of experts voting either "strongly agree" or "agree." Results: A total of 45 consensus statements were evaluated, of which 21 (46.6%) achieved the predefined level of consensus. Conclusions: This document aims to establish standardized guidelines to improve cataract surgery outcomes by minimizing the risk of postoperative endophthalmitis. For areas where consensus was not achieved, the panel recommends further investigation and continued research to guide future updates to clinical practice.
Citation
Sharma N, Bari A, Rao SK, Agrawal R, Allen PJ, Buchan JC, Chang A, Chang DF, Chee SP, Chen W, Chen KJ, Chow VWS, Das T, Dave VP, Flynn HW Jr, Felfeli T, Fung AT, Grzybowski A, Ho M, Lam WC, Low L, Lundström M, Mieler WF, Radke NV, Ruamviboonsuk P, Rohowetz LJ, Sharma S, Sharma T, Suzuki T, Tsang CW, Yao K, Young AL, Zhang M, Zheng K, Lam DSC. Controversies, Consensuses, and Guidelines on Preventing, Diagnosing and Managing Acute-onset Bacterial Endophthalmitis after Cataract Surgery by the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO), the Asia-Pacific Vitreo-retina Society (APVRS), and the Asia-Pacific Society of Ocular Inflammation and Infection (APSOII). Am J Ophthalmol. 2025 Dec;280:436-457. doi: 10.1016/j.ajo.2025.08.031. Epub 2025 Aug 16
Type
Article