Using the West Midlands CONCERT to characterise regional incidence of acute-onset post cataract surgery endophthalmitis

• Published in: Eye (London) 2021-06, Vol.35 (6), p.1730-1740
• Main Authors: Moussa, George, Bhatt, Hetvi, Reekie, Ian, Butt, Gibran, Ng, Aaron, Blanch, Richard, Rauz, Saaeha
• Format: Article
• Language: English
• Subjects: 692/308/174; 692/699/3161; Cataracts; Clinical trials; Endophthalmitis; Eye surgery; Feasibility studies; Laboratory Medicine; Medicine; Medicine & Public Health; Ophthalmology; Patients; Pharmaceutical Sciences/Technology; Surgery; Surgical Oncology; Training
• ISSN: 0950-222X; 1476-5454
• DOI: 10.1038/s41433-020-01158-6

Background Whilst research and innovation is embedded within the UK’s National Health Service (NHS) constitution, Doctors-in-training have little opportunity to contribute to designing, leading and recruiting into clinical trials or cohort studies. We formed the West Midlands C ollaborative O phthalmology N etwork for C linical E ffectiveness & R esearch by T rainees (The West Midlands CONCERT) and undertook a characterisation of post cataract surgery endophthalmitis as a proof-of-concept study to test the feasibility of the CONCERT model. Methods Doctors-in-training formed a collaborative working group to test the concept of delivering a pan-regional clinical effectiveness study across multiple hospital sites by performing retrospective analyses of post cataract endophthalmitis over a 6-year period. Results Overall, 157,653 cataract surgeries were performed by participating centres accredited to deliver the Royal College of Ophthalmologists training curriculum. Thirty-eight cases of post cataract endophthalmitis were identified, giving an incidence of 2.41 per 10,000 cases (0.0241%). A further 15 endophthalmitis cases presented who had surgery in non-training centres, giving a total of 53 cases. The most common organisms were S. epidermidis (14 (51.9%)) and P. aeruginosa (5 (18.5%)). Anterior-chamber and vitreous sampling yielded positive culture in 33.3% (6/18) and 50.9% (27/53), respectively. At 6 months follow-up, 19 (51.4%) patients achieved visual acuities of ≤0.5 LogMAR. Repeat intravitreal injections (11 (20.8%)) and vitrectomy ( n  = 22 (41.5%)) were not associated with better outcomes. Conclusions Using post cataract endophthalmitis as a pilot cohort, this study highlights the feasibility of using the CONCERT model for studies across multiple sites. A UK-CONCERT could provide a powerful infrastructure enabling characterisation of patient cohorts and a platform for high-quality interventional studies, improving patient care.