New findings from a study published in Ophthalmology evaluated major risk factors for post-cataract surgery endophthalmitis.
Talk about this research.
Using the Royal College of Ophthalmologists’ National Ophthalmology Database (RCOphth NOD), a team of investigators analyzed phacoemulsification data from 76 centers by 3,570 surgeons.
Included in this were 1,351,415 cataract surgeries performed on 920,286 patients between April 2010 and March 2021.
How was endophthalmitis defined in the study?
Patients were defined as having endophthalmitis if the following occurred within 42 days of cataract surgery:
- Postoperative complication record of endophthalmitis
- Postoperative diagnosis of endophthalmitis
- Post-cataract vitreous biopsy or anterior chamber tap
What was the prevalence of endophthalmitis?
Endophthalmitis was recorded in 308 (0.02%) eyes, with no cases from any of the 2,315 immediate sequential bilateral cataract surgery patients.
Of this patient population, 171 (55.5%) were female, and the median age was 76.9 (interquartile range [IQR] 68.8-84.0).
Additionally, the research team noted that the post-cataract surgery endophthalmitis rate ranged from 0.015 to 0.035% between 2010 and 2020.
What risk factors were linked with endophthalmitis?
Key risk factors included:
- Posterior capsular rupture (odds ratio [OR] 7.111, 95% confidence interval [CI] 4.890-10.341)
- Uveitis/posterior synechiae (OR 4.315, 95% CI 2.467-7.549)
- Previous vitrectomy surgery (OR 2.879, 95% CI 1.411-3.523)
- Previous anti-vascular endothelial growth factor (VEGF) therapy (OR 2.230, 95% CI 1.307-3.417)
- Glaucoma (OR 2.114, 95% CI 1.591-2.810)
- Corneal pathology (OR 2.113, 95% CI 1.307-3.417)
- Diabetes mellitus (OR 1.450, 95% CI 1.114-1.886)
How did these stratify?
Based on the risk factor model, the lowest probability of post-cataract surgery endophthalmitis was 0.015% for patients without diabetes mellitus, who had not received anti-VEGF therapy, with none of the listed ocular conditions, as well as no having no posterior capsule rupture (PCR )during surgery.
This risk increased to 0.108% with the presence of PCR.
The highest-risk eyes were from patients with all of the risk factors listed above; without PCR, the risk of endophthalmitis was 2.645%, and with PCR, the risk increased to 16.139%.
Tell me more about PCR.
PCR during cataract surgery is a significant risk factor for endophthalmitis; once there is a breach to the posterior capsule, additional procedures and instruments—such as anterior vitrectomy—are required.
Necessitating additional surgical time, PCR increases the risk of introducing microorganisms into the eye.
Anything else?
There was no statistically significant difference in the rate of endophthalmitis based on the grade of the operating surgeon.
Take home.
The data demonstrates the utility of large-scale clinical databases for risk factor analysis of rare surgical complications.
These findings could help surgeons to discuss potential risks with patients and allow them to factor in strategies to reduce these risks, as well as serve as a baseline for benchmarking data.
Next steps?
The study authors recommended the implementation of national benchmarks of incidence and risk-stratified surveillance of endophthalmitis outbreaks.
Additionally, they advocated for the “development of national prospective surveillance networks to monitor endophthalmitis cases in real-time, along with their microbiology and anti-microbial resistance data,” to help with reducing the infection rate, allow for quick identification of outbreaks, and guide response measures.