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  • Endophthalmitis Risk of Sequential Bilateral Cataract Surgery

    By Lynda Seminara
    Selected by Stephen D. McLeod, MD
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    Journal Highlights

    Ophthalmology, January 2022

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    Friling et al. compared postoperative endophthalmitis rates for unilateral cataract surgery and immediate sequential bilateral cataract surgery (ISBCS) and found that the risk of infection was lower with ISBCS.

    The investigators began by gathering data for endophthalmitis cases reported to the Swedish National Cataract Reg­ister during a 16-year period (2002-2017). They compared incidence and other details of postoperative endoph­thalmitis for IBSCS versus unilateral surgery (control group). They also assessed patient characteristics, surgical techniques, and capsular complications.

    Of the 1,457,172 cataract extractions, endophthalmitis occurred in 422, repre­senting an overall incidence of 0.029%. The rate of post-op endophthalmitis was 0.0299% (408 of 1,364,934 operations) for unilateral procedures and 0.0152% for ISBCS (14 of 92,238 opera­tions; p = .01).

    According to logistic regression analysis of all cataract extractions, risk factors independently linked to post­operative endophthalmitis included capsular complications, older patient age (≥85 years), male gender, ocular comorbidity, and no use of intracamer­al antibiotics. All of these factors were present in both cohorts, but each was less common in the ISBCS group. In the same multivariate analysis, ISBCS carried a significantly lower risk of endophthalmitis.

    Overall, even though the endoph­thalmitis rate seems to be lower with ISBCS than with unilateral extraction, it is not negligible. Thus, the authors said, it is crucial to exercise caution. Of note, during follow-up, visual acuity for five of the 14 patients with ISBCS-re­lated endophthalmitis was 20/200 or worse. One such patient, a 93-year-old, had endophthalmitis postoperatively in both eyes.

    In addition, the authors hypothe­sized that if the surgeons would have routinely used intracameral antibi­otic prophylaxis with ISBCS and had refrained from offering the bilateral procedure to patients over 84 years of age, the incidence of post-op endoph­thalmitis could have been as low as 0.0073% (six of 81,226 eyes). They sug­gested that these data will be useful for decision-making for patients for whom ISBCS may be an option.

    The original article can be found here.