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).

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.