Clear corneal incision (CCI) is not a risk factor for post-cataract surgery endophthalmitis, said I. Howard Fine, MD, at Spotlight on Cataracts 2007.

Speaking in support of the technique he introduced in 1992 and that is now preferred by the overwhelming majority of cataract surgeons, Dr. Fine pointed out that the available literature examining the association between CCI and endophthalmitis is contradictory. While there are some studies demonstrating a relationship, several large studies find the incidence of endophthalmitis is not increased by CCI surgery.

Other factors that need to be considered are changing microbial resistance patterns to antibiotics commonly used for endophthalmitis prophylaxis. Proper CCI construction is also paramount.

"Clearly, not all CCIs are the same and we cannot lump them all together and discuss them as if they were," Dr. Fine said. "The literature on this topic is incomplete because there has been no standardization or description of CCI construction, architecture, or profile in the published studies."

It also appears that more careful attention needs to be paid to construction of the side-port incision, and consideration may be given to the possibility that a shift to temporal surgery accompanying the transition to the CCI may play a role in endophthalmitis rates.

"For a right-handed coaxial surgeon operating on left eyes, the side-port incision is located in the inferior conjunctiva cul-de-sac," Dr. Fine said. "It would be interesting to review the literature reporting an increased incidence of endophthalmitis with CCI to see if it was left eyes that predominated. Perhaps this factor is the culprit in what appears to be an increased incidence of endophthalmitis with the introduction of the CCI."