Cases of endophthalmitis following cataract surgery have decreased in number

This study assessed the causes and incidence of postoperative acute endophthalmitis in France. The results show changing trends for endophthalmitis occurring after cataract surgery and intravitreal injections.

Study design

Endophthalmitis cases and intraocular procedures were identified based on billing codes in all hospitals and outpatient locations in France. The French National Health information database was analyzed for data over a 10-year period. All endophthalmitis cases are treated as inpatients in France and are therefore recorded in this database.

Outcomes

Between 2009 and 2018, 7522 cases of endophthalmitis occurred after 14,438,854 intraocular procedures. Cataract surgery was the most common procedure associated with endophthalmitis, accounting for 64% of the cases, an incidence of 1 in 1522. The second most common procedure leading to endophthalmitis was intravitreal injections and this demonstrated an incidence of 1 in 4210. Surprisingly, vitreoretinal surgery was the third most common procedure leading to endophthalmitis with an incidence of 1 in 634. Of note, the incidence of endophthalmitis cases after cataract surgery decreased during the time period of the study.

Limitations

The primary outcome measures were limited to endophthalmitis that occurred within 42 days of a procedure, as defined by the Endophthalmitis Vitrectomy Study. This likely eliminates many cases of post-filtering surgery endophthalmitis as those cases often have a delayed onset years after surgery. This study also did not use culture criteria to prove infectious endophthalmitis and therefore could have included some cases of sterile endophthalmitis. Finally, in some cases multiple procedures were performed prior to the acute endophthalmitis and it may be difficult to ascertain which procedure actually caused the endophthalmitis.

Clinical significance

This study demonstrates an overall low incidence (0.0521 per 100 procedures) of endophthalmitis after intraocular procedures. The decrease in the incidence of endophthalmitis after cataract surgery during this time period may reflect improved microsurgical techniques as well as the beneficial effect of intracameral antibiotics. In contrast, the high incidence of endophthalmitis after vitrectomy surgery underlines the importance of mitigating risk. Suturing sclerotomies to help decrease endophthalmitis risk and adding a tamponade agent may serve as easy steps to lower rates of endophthalmitis following vitrectomy.