Patient Profile in Acute Endophthalmitis Referral Evolved Over a Decade

Catherine Creuzot-Garcher, MD

New findings suggest the profile of patients referred for acute endophthalmitis has undergone an evolution over the past decade.

The data show a decrease in the raw number of endophthalmitis cases after cataract surgery in opposition to an increase in the number of patients who presented with endophthalmitis after intravitreal injections.

“The overall incidence of acute endophthalmitis was 1 per 1920 procedures,” wrote study author Catherine Creuzot-Garcher, MD, PhD, Department of Ophthalmology, University Hospital, Dijon, France.

Alongside colleagues, Creuzot-Garcher set out to describe the causes of postoperative acute endophthalmitis longitudinally, on the national scale. The cohort study occurred from 2009 to 2018 in France.

The included participants were individuals diagnosed with acute endophthalmitis after intraocular procedures. Investigators collected information on patients from the French medical-administrative database.

They identified endophthalmitis cases and intraocular procedures based on billing codes in all French hospitals and private practices. The study’s main outcome was the incidence of acute endophthalmitis within 42 days of the procedure.

Over January 2009 to October 2018, a total of 7522 cases of acute endophthalmitis occurred after 14,438,854 intraocular procedures. The majority of cases were found to occur after standalone cataract surgery (4808 cases for 7,316,077 procedures; 63.92%), followed by after intravitreal injections (1296 cases for 5,455,631 intravitreal injections; 17.23%).

These were then followed by vitreoretinal surgery (698 for 442,263 procedures; 9.28%), anterior segment surgery (245 cases; 3.26%), combined cataract and vitreoretinal surgery (698 for 442,263 procedures; 9.28%), anterior segment surgery (245 cases; 3.25%), combined cataract and vitreoretinal surgery (191 cases, 2.54%), cornea surgery (142 cases, 1.89%), and glaucoma surgery (80 cases, 1.06%).

Investigators saw the overall incidence rate of acute endophthalmitis was 0.0521% (95% confidence interval [CI], 0.0520 - 0.0522). The surgery with the highest incidence of endophthalmitis was scleral and globe surgery, at an incidence of 0.1827% (95% CI, 0.1757 - 0.1898).

The next highest incidence was vitreoretinal surgery combined with cataract surgery, at an incidence of 0.1685% (95% CI, 0.1663 - 0.1706). Data show the incidence of endophthalmitis after intravitreal injection was stable throughout the stable period, and those receiving intravitreal injections were the oldest at an age of 75.4 years (standard deviation, 12.0 years; P <.001).

Moreover, the onset of endophthalmitis after intravitreal procedures, including injection or undergoing vitreoretinal surgery, was earlier than after the other procedures (P <.001).

The study, “Epidemiology of Acute Endophthalmitis after Intraocular Procedures: A National Database Study,” was published in Ophthalmology.