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

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 Collaborative Ophthalmology Network for Clinical Effectiveness & Research by Trainees (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: 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. Conclusion: 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.