Incidence of Endophthalmitis after Cataract Surgery in the Setting of Uveitis and Immunosuppressive Therapy within the IRIS® Registry.

PURPOSE

To determine the differences in incidence of acute postoperative endophthalmitis after cataract surgery in the setting of uveitis and immunosuppressive therapy using the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight).

DESIGN

Retrospective cohort study.

PARTICIPANTS

Patients undergoing cataract surgery in the United States from 2013 to 2023.

METHODS

The IRIS Registry was queried to identify cataract surgeries performed between January 1, 2013, and March 21, 2023. Postoperative endophthalmitis was identified based on endophthalmitis diagnosis codes and vitreous tap and intravitreal antibiotic injection within 60 days after surgery. Cases with a recent noninfectious uveitis diagnosis within 1 year before cataract surgery were also identified. Active use of systemic corticosteroids and immunosuppressives was determined using drug names and the National Library of Medicine Rx Concept Unique identifier. Eyes that underwent cataract surgery were classified into 4 groups: Group A: Eyes with no uveitis in patients with no concurrent systemic corticosteroid or immunosuppressive treatment (general population). Group B: Eyes with recent uveitis in patients with no concurrent systemic corticosteroid or immunosuppressive treatment. Group C: Eyes with no uveitis in patients with concurrent systemic corticosteroid or immunosuppressive treatment. Group D: Eyes with recent uveitis in patients with concurrent systemic corticosteroid or immunosuppressive treatment. Multivariable logistic regression was performed to evaluate the likelihood of endophthalmitis.

MAIN OUTCOME MEASURES

Incidence of acute-onset postoperative endophthalmitis in eyes with a uveitis diagnosis and in eyes of patients under systemic corticosteroid and immunosuppressive therapy.

RESULTS

A total of 9 742 773 cataract surgeries were identified; of those, 128 254 were in patients on systemic corticosteroids or immunosuppressives at the time of surgery. The incidence of acute postoperative endophthalmitis within 60 days after surgery was 0.058%, 0.468%, 0.137%, and 0.964%, in groups A, B, C, and D, respectively. The highest incidence of endophthalmitis diagnoses was in eyes with uveitis diagnoses; however, among eyes with and without uveitis, endophthalmitis incidence was higher in patients treated with immunosuppressives or corticosteroids. Multivariate logistic regression analysis revealed that systemic corticosteroids were more associated with endophthalmitis compared with systemic immunosuppressives.

CONCLUSIONS

Underlying uveitis diagnosis, systemic corticosteroids, and immunosuppressives are associated with an increased likelihood of acute postoperative endophthalmitis after cataract surgery.

FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.