Kerrison Caroline H, Chang David F, Dun Chen, Sabharwal Jasdeep, Woreta Fasika A
From the University of South Carolina School of Medicine, Columbia, South Carolina (Kerrison); Altos Eye Physicians, Los Altos, California (Chang); The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Dun, Sabharwal, Woreta).
J Cataract Refract Surg. 2025 Feb 1;51(2):91-97. doi: 10.1097/j.jcrs.0000000000001563.
To assess postoperative endophthalmitis (POE) rates and risk factors after secondary intraocular lens (IOL) implantation for preoperative aphakia and IOL exchange combined with or without vitrectomy.
Medicare fee-for-service (FFS) beneficiaries, United States.
Retrospective study.
Medicare FFS beneficiaries who underwent IOL exchange or secondary IOL implantation for preoperative aphakia between January 1, 2011, and November 19, 2022, were identified. POE rates were calculated overall and separately for each surgical category-secondary IOL for aphakia vs IOL exchange, with subsets for concurrent anterior or posterior vitrectomy. Multivariate analysis of potential risk factors was implemented.
97 152 patients were included. The 42-day POE rates for secondary IOL implantation for aphakia and for IOL exchange were 0.35% and 0.28% overall, 0.31% and 0.30% when combined with posterior vitrectomy, and 0.84% and 0.42% with anterior vitrectomy, respectively. The risk of POE increased when secondary IOL surgery was combined with anterior vitrectomy compared with no vitrectomy (adjusted odds ratio [aOR], 1.849; P < .001) and with higher Charlson Comorbidity Indexes compared with 0: 1 to 2 (aOR, 1.495; P = .01), 3 to 4 (aOR, 1.591; P = .01), 5 to 6 (aOR, 1.617; P = .046), and ≥7 (aOR, 3.290; P < .001). Risk was decreased for IOL exchange compared with secondary IOL implantation for preoperative aphakia (aOR, 0.783; P = .04).
The overall POE rate for all secondary IOL surgeries was 0.31% during the 11-year period. We hypothesize that the absence of the posterior capsular barrier would explain the higher POE rates compared with cataract surgery, especially if a concurrent vitrectomy was performed with the secondary IOL procedure.
评估术前无晶状体眼二期人工晶状体（IOL）植入术以及IOL置换术（联合或不联合玻璃体切除术）后的术后眼内炎（POE）发生率及危险因素。
美国医疗保险按服务收费（FFS）受益人群。
回顾性研究。
确定2011年1月1日至2022年11月19日期间因术前无晶状体眼接受IOL置换术或二期IOL植入术的医疗保险FFS受益人群。计算总体POE发生率，并按手术类别分别计算——无晶状体眼二期IOL植入术与IOL置换术，同时将同期行前部或后部玻璃体切除术的亚组纳入分析。对潜在危险因素进行多变量分析。
共纳入97152例患者。无晶状体眼二期IOL植入术和IOL置换术的42天POE总体发生率分别为0.35%和0.28%，联合后部玻璃体切除术时分别为0.31%和0.30%，联合前部玻璃体切除术时分别为0.84%和0.42%。与未行玻璃体切除术相比，二期IOL手术联合前部玻璃体切除术时POE风险增加（调整优势比[aOR]，1.849；P <.001）；与Charlson合并症指数为0相比，指数为1至2（aOR，1.495；P =.01）、3至4（aOR，1.591；P =.01）、5至6（aOR，1.617；P =.046）以及≥7（aOR，3.290；P <.001）时POE风险增加。与术前无晶状体眼二期IOL植入术相比，IOL置换术的风险降低（aOR，0.783；P =.04）。
在这11年期间，所有二期IOL手术的总体POE发生率为0.31%。我们推测，与白内障手术相比，后囊膜屏障的缺失可解释POE发生率较高的原因，特别是在二期IOL手术同时行玻璃体切除术时。
