Findings from a recent study published in Ophthalmology examined how endophthalmitis rates differ between adult and pediatric patients across common eye procedures, drawing on more than 17 million surgeries logged in the American Academy of Ophthalmology Intelligent Research in Vision (IRIS) Registry.
The headline finding: Pediatric patients had a meaningfully higher risk of infection following cataract surgery.
Give me some background first.
Though endophthalmitis after eye surgery is rare, when it happens it can cause irreversible vision loss.
- Case in point: A prior IRIS Registry analysis of 8.5 million cataract surgeries from 2013 to 2017 found an overall acute-onset endophthalmitis rate of 0.04%, with the youngest age subset (1 to 17 years) showing the highest incidence.
This new research extends that picture, comparing pediatric and adult outcomes across a wider set of procedures.
Now, talk about the study.
Researchers ran a retrospective clinical cohort analysis using the IRIS Registry, pulling pediatric and adult patients diagnosed with acute endophthalmitis within 30 days of an ophthalmic procedure performed between 2016 and 2024.
The question: Do endophthalmitis rates after common eye surgeries differ between kids and adults, and which procedures show the biggest gap?
Who was included in the study?
Sample: 17,457,881 procedures were analyzed across both age groups.
Procedures captured: Cataract surgery, vitrectomy for retinal detachment, trabeculectomy, tube shunts, scleral buckle surgery, strabismus surgery, and open globe repair.
Outcome window: Acute endophthalmitis diagnosed within 30 days of surgery.
And the findings?
Among adults, open globe repair carried the highest risk at 0.94% (1 case per 106). Vitrectomy for retinal detachment came in at 0.097% (1 per 1031), trabeculectomy at 0.1% (1 per 1000), and tube shunts at 0.075% (1 per 1333).
Scleral buckle surgery in adults sat at 0.068% (1 per 1459), cataract surgery at 0.038% (1 per 2652), and strabismus surgery at 0.011% (1 per 9091).
The gap: Pediatric cataract surgery had an endophthalmitis rate of 0.11% (1 case per 871)—nearly three times the adult rate of 0.038%. This difference reached statistical significance (P = 0.014).
Other pediatric figures:
- Open globe repair at 0.87% (1 per 115)
- Vitrectomy for retinal detachment at 0.084% (1 per 1190)
- Strabismus surgery at 0.0072% (1 per 13884)
Also notable: Scleral buckle surgery in kids was reported at 0.415% (1 per 675), substantially higher than the adult rate of 0.068%.
One comparison that didn’t move: Same-day cataract plus glaucoma surgery did not show a significantly different endophthalmitis rate compared with glaucoma surgery alone.
Any limitations to consider?
A few …
- This was a registry-based retrospective analysis, which carries the usual caveats
- Diagnostic and procedural coding may have introduced misclassification
- Unmeasured confounders like underlying anatomical complexity or postoperative adherence in pediatric patients weren’t fully accounted for
Additionally, the study’s abstract did not report adjusted risk ratios for the procedures it covered.
Expert opinion?
The authors’ position: The higher pediatric infection rate after cataract surgery may reflect a combination of anatomical differences, increased surgical complexity, and postoperative care challenges such as medication adherence.
The take home.
For clinicians caring for pediatric cataract surgery patients, this dataset suggests the postoperative infection risk runs meaningfully higher than what’s typical in adults.
In practice: Tighter perioperative vigilance and structured family education on drop adherence are reasonable responses to the elevated risk profile this study documents.