Postoperative Endophthalmitis: Rates and Risk Factors

Journal Highlights

British Journal of Ophthalmology
Published online Sept. 21, 2023

Download PDF

The rarity of postoperative endophthalmitis makes it difficult to determine the prevalence and risk factors. Chen et al. analyzed data for a large Medicare population and found that the overall endophthalmitis rate within 42 days of intraocular surgery was 0.09%. Some surgeries were linked to a higher rate of this complication, including corneal transplantation (0.43%) and placement of a secondary IOL (0.36%).

For this work, the authors compiled 2016-2019 claims data for Medicare Advantage and fee-for-service members, from which they identified eyes that had intraocular surgery. Patients with recent endophthalmitis or intravitreal injection were excluded. Main outcome measures were risk factors and the overall and surgery-specific rates of endophthalmitis.

Among 9,744,400 cases that qualified for the analysis, the overall endophthalmitis rate within 42 days post-op was 0.09%. Endophthalmitis was diagnosed at a median of seven days and a mean of 10.35 days following surgery. Classification by surgery type revealed that the endophthalmitis rate was highest with corneal transplantation (0.43%), followed by secondary IOL implantation (0.36%), retina surgery (0.24%), glaucoma surgery (0.16%), and cataract surgery combined with other procedures (0.11%). The rate was lowest after standalone cataract extraction (0.08%), the most common type of intraocular surgery. According to multivariable analysis, older patients were more likely than younger patients to experience endophthalmitis (adjusted odds ratios [aORs], 1.09 for ages 65-74 and 1.36 for ages >84), as were men (aOR, 1.20) and patients with a Charlson Comorbidity Index ≥7 (aOR, 1.79 vs. score of zero). The rate of endophthalmitis was lowest in calendar year 2019 (aOR, 0.91). Racial differences were not significant.

These results boost knowledge of the epidemiology of endophthalmitis after intraocular surgery, said the authors, who hope their data will guide future strategies to mitigate this complication.

The original article can be found here.