Johann Sebastian Bach, considered to be the most famous sacred musician of all time died in 1750 eventually because of the consequences of endophthalmitis due to his unsuccessful cataract surgery6,10,11,12,13,14.

1
From Bach to Barry endophthalmitis now and
then Sibylle K. Scholtz, Gerd U. Auffarth
International Vision Correction Research Centre
(IVCRC), Dept. of Ophthalmology, University of
Heidelberg, Germany No financial interests
Johann Sebastian Bach (1685 1750)16
Peter Barry5
Introduction
Johann Sebastian Bach, considered to be the most
famous sacred musician of all time died in 1750
eventually because of the consequences of
endophthalmitis due to his unsuccessful cataract
surgery6,10,11,12,13,14. This study showed that
intracameral cefuroxime administered at the time
of surgery significantly reduced the risk for
developing endophthalmitis after cataract
surgery1,5,7,8,15,17.
Still today the risk of endophthalmitis in
cataract surgery is not overcome completely even
having modern surgical techniques and several
antibiotics available1,8. This poster wants to
highlight the achievements in modern ophthalmic
medicine that led to the ESCRS Guidelines for
endophthalmitis prophylaxis presented by Peter
Barry over the last two years1,8.
2
Johann Sebastian Bach and his probably
fatal cataract surgery
In August 1748, Bachs hand writing began to
indicate that he had trouble with his eyes it is
likely that he suffered from cataract. There are
no documents written by him after 1749, his wife
or his son signed important documents on his
behalf. At age 65, Bach decided to undergo
cataract surgery in late March of 1750 by famous
John Taylor. Taylor operated exclusively on the
left eye of his patients, never mind which eye
was worse affected by the cataract2,6,9,10,11.
Johann Sebastian Bach 174616
3
Johann Sebastian Bach and his probably
fatal cataract surgery
The method of couching Taylor used was very
painful and dangerous Proper anaesthesia (apart
from alcohol and opiates) was not available,
nobody knew about the importance of disinfecting
eyes or surgical tools. Taylor
prepared his patients for surgery with laxatives,
bloodletting and eye drops made from pigs blood,
sugar and salt. Moreover, the surgery was not
performed at a hospital, but on an outpatient
basis (e.g. at inns)2,3,4,6.
Johann Sebastian Bachs eyes, detail from the
Haussmann painting16
4
Johann Sebastian Bach and his probably fatal
cataract surgery
Bach had his first eye surgery between March 28
and 31, 1750. Shortly after the operation, the
local newspaper published an article reporting
that Bachs vision had improved, which is not a
very believable source, since Taylor often issued
publications of such reports to advertise his
business. Meanwhile, Taylor had moved on to treat
other peoples cataract2,3,4,6,10.
Bach 1750 and his signature16
When he came back to Leipzig, he performed
another operation on Bach, between April 5 and 7,
1750. It is said that Bach went completely blind
after the second surgery2,3,6.
5
Johann Sebastian Bach and his probably fatal
cataract surgery
We will never find out what exactly happened to
him. If Bach was completely blind after the
second surgery (app. 5. 7. April 1750), and if
Taylor had again just treated one eye, the
cataract in the other eye must have been very
advanced, so that the eye was blind or had
extremely limited vision. Reports also indicate
that Bach was suffering from severe pain in his
eyes, which may have been caused by increasing
ocular pressure or by a deteriorating eye
infection2,3,4,6. An eye infection could have
caused blood poisoning, which would have been
life threatening. Sources reporting that Bach had
a high fever support this view2,3,4,6. After
weeks of suffering, Bach died on July 28, 1750,
in Leipzig10. Taylor had long departed
Bachs bust19
6
The ESCRS endophthalmitis study
This was the largest study of an antibiotic in
the history of medicine (Peter Barry15)

• The ESCRS study1,8 aimed to answer two questions
• Do perioperative antibiotics prevent
  endophthalmitis?
• Should antibiotics be administered
  intracamerally, topically, or both?
• The studys objectives were the efficacy of the
  use of intracameral cefuroxime and intensive
  perioperative antibiotics versus placebo.
• Preoperative antibiotic drops were not used in
  the conventional sense7.

ESCRS endophthalmitis study, study groups1
7
The ESCRS endophthalmitis study
Of 15,971 patients enrolled from 23 clinics
across nine European countries, half received 1mg
of intracameral cefuroxime in 0.1ml of normal
saline solution. All patients received
povidone-iodine preoperatively and also were
randomized to receive either topical levofloxacin
or placebo drops7,17. Postoperatively, all
patients received topical levofloxacin drops four
times a day for 6 days starting on postoperative
day one7,17. The ESCRS study reasonably
and accurately defined the true ratio of
endophthalmitis and unequivocally demonstrated
the effect of cefuroxime. If cefuroxime was
commercially available in a single, sterile,
ophthalmic unit dose, it would become the gold
standard of endophthalmitis prevention7.
Results of analysis of total endophthalmitis
cases1
8
The ESCRS endophthalmitis study
Potential risk factors for endophthalmitis
identified by the study included the use of a
silicone IOL and clear corneal incisions1,5,7,8,15
,17.
Significant risk factors for presumed
endophthalmitis7
I would therefore appeal wholeheartedly to the
industry to provide us with a single sterile unit
dose of cefuroxime for the many millions of
cataract procedures that are performed annually
worldwide (Peter Barry)15
9
Conclusions
The celebrated British eye surgeon John Taylor
performed surgery on Bach twice visiting Leipzig
in March/April 1750. Bach died July 28th 1750,
aged 65. Contemporary newspapers reported on
Bachs death as "from the unhappy con-sequences
of the very unsuccessful eye opera-tion2,3,4,6.
Todays view is that Bach died finally because
of endophthalmitis. At that time a successful
cataract surgeon achieved about 80 - 90
surviving eyes4,6. We do not know the exact
number of endophthalmitis cases at that time,
however, over the last two centuries it dropped
down to below 0.1 to 0.01. Barrys ESCRS study
results represent todays best proven ways of
prophylaxis1,8,18.
Bach statue in Leipzig (D)16
10
Results
At Bachs time cataract surgery was a very
dangerous treatment due to infections because of
a bad hygienic situation then. This is today not
the fact anymore. There are antibiotics available
as well as modern surgical techniques. Peter
Barrys ESCRS study results provide a fundamental
under-standing of endophthalmitis today.
Peter Barry giving Ridley Medal Lecture15
References 1Barry P, Seal DV, Gettinby G, Lees
F, Peterson M, Revie C for the ESCRS
Endophthalmitis Study Group, ESCRS study of
prophylaxis of postoperative endophthalmitis
after cataract surgery, Preliminary report of
principal results from a European multicenter
study, J Cataract Refract Surg 2006 32407410,
2 Zegers, R.A., The Eyes of Johann Sebastian
Bach, Arch Ophthalmol, Vol. 123, Oct. 2005, 3
Kubba, A.K., Young, M., Johann Sebastian Bachs
disastrous operation, IJCP, July/August 1997, 4
Glaukom-aktuell, Sekundärglaukom,
Endophthalmitis, Sepsis das lange Sterben des
Johann Sebastian Bach, Glaukom-aktuell, 1/2006,
5 Barry, P., ESCRS study on antibiotic
prophylaxis of endophthalmitis yields positive
result, Editorial, EuroTimes 03/2006, 6
Scholtz, S., Augenblick, Saarbrücken 2007, 7
Barry, P., Endophthalmitis Recommendations Based
on the ESCRS Study, J Cataract Refract Surg
Today, 04/2007, 63 65, 8 Seal D, Barry P,
Gettinby G, et al. ESCRS study of prophylaxis of
postoperative endophthalmitis after cataract
surgery case for a European multicentre study. J
Cataract Refract Surg 200632396-406, 9
Toellner, R., Illustrierte Geschichte der
Medizin, Vaduz 1992, 10 Korff, M., Johann
Sebastian Bach, München 2000, 11 Geck, M.,
Bach. Leben und Werk, Reinbek 2001, 12 Wolff,
C., Johann Sebastian Bach, Frankfurt 2005, 13
www.bach.de, 14 http//www.npj.com/thefaceofbach
/index.html, 15 Barry P, Endophthalmitis
following cataract surgery is preventable,
EuroTimes 03/2006, 16 http//de.wikipedia.org/wi
ki/Johann_Sebastian_Bach, 17 Barry P, Lessons
From the ESCRS Study on Endophthalmitis
Prophylaxis, Cataract Refractive Surgery Today
Europe, 9/2008, 54 56, 18 Leitlinie zur
Prophylaxe und Therapie von Endophthalmitiden,
Deutschsprachige Gesellschaft für
Intraokularlinsen-Implantation und refraktive
Chirurgie (DGII), August 2005, 19
http//www.lastfm.de/music/JohannSebastianBach/
images/40791525.