Endophthalmitis after Cataract Surgery in Korea: A Nationwide Study Evaluating Incidence and Risk Factors in a Korean Population

Abstract

Purpose To assess the nationwide rate of acute postoperative endophthalmitis (APE) after cataract extraction in Korea and to evaluate potential risk factors thereof. Materials and Methods Nationwide insurance claims data from July 2014 to June 2017 were reviewed. All patients with phacoemulsification or extracapsular/intracapsular cataract extraction were included. Exclusion criteria were combined glaucoma surgery or total vitrectomy or when the patient had a history of intraocular foreign body. Results In total, 1505103 cases (982203 patients) were included. APE developed in 953 cases (938 patients) with an overall incidence of 0.063%. After adjusting for possible confounding factors, male sex [odds ratio (OR) 1.42; 95% confidence interval (CI) 1.25–1.61; p <0.001], primary clinical setting, operations performed in non-major cities, usage of sutures (OR 2.82; 95% CI 2.13–3.74; p <0.001), anterior vitrectomy (OR 8.71; 95% CI 6.71–11.32; p <0.001), aphakic cataract surgery (OR 1.52; 95% CI 1.03–2.22; p =0.033), hypertension (OR 1.40; 95% CI 1.18–1.66; p <0.001), diabetes (OR 1.59; 95% CI 1.31–1.93; p <0.001), and chronic renal failure (OR 1.28; 95% CI 1.01–1.62; p =0.039) were found to be related to APE development. Conclusion The incidence of APE after cataract extraction was consistent with reports from other studies. Additional research is needed to determine the relationship of newly found risk factors, such as hypertension, primary clinical setting, chronic renal failure, and usage of suturing, with APE development.

Predisposing Factors for Severe Complications after Cataract Surgery: A Nationwide Population-Based Study

“…The DM is a component of metabolic syndrome, and the presence of DM correlates with the development of postoperative complications in cataract surgery [ 15 , 18 , 26 ]. In a previous study, DM was associated with a higher rate of cystoid macular edema [ 8 ], and other studies demonstrated that DM patients were prone to develop postoperative endophthalmitis [ 10 , 27 ]. In the current study, DM is also a significant risk factor for major postoperative complications of cataract surgery with a prominent aOR of 2.818, consistent with the results from previous research.…”

“…Except for DM, other metabolic diseases, including hypertension and dyslipidemia, and hyperlipidemia, also correlated with the development of postoperative complications in the current study. Hypertension may lead to poor postoperative status, including delay wound healing in root canal treatment and a higher rate of postoperative endophthalmitis [ 10 , 33 ]. Conversely, the dyslipidemia status can damage the vascular endothelium and lead to the formation of atherosclerotic plaque [ 34 ].…”

“…Intraoperative complications are a common risk factor for postoperative complications. Posterior capsular rupture with or without vitreous loss during cataract surgery is associated with a higher rate of retinal detachment, cystoid macular edema, and postoperative endophthalmitis [ 8 , 9 , 10 ]. Moreover, other negatively intraoperative statuses, including thermal damage and prolonged phacoemulsification time, can also lead to the development of pseudophakic bullous keratopathy [ 7 ].…”

“…In addition to ocular conditions, certain systemic disorders are related to the postoperative complications of cataract surgery [ 10 , 15 ]. Males display a higher rate of retinal detachment and postoperative endophthalmitis after cataract surgery [ 9 , 16 , 17 ].…”

“…However, few studies have discussed whether other systemic diseases relate to the universal development of postoperative complications. One study revealed the incidence of postoperative endophthalmitis in a patient with hypertension and chronic kidney disease [ 10 ], and another study revealed the incidence of postoperative suprachoroidal hemorrhage in a patient with cardiovascular disease, peripheral vascular disease, and hyperlipidemia [ 19 ]. Since the presence of metabolic syndrome, chronic kidney disease, and autoimmune disorders can impair ocular condition [ 20 , 21 , 22 ], it is possible that related systemic diseases serve as a risk factor for postoperative complications of cataract surgery in which the pre-existing systemic disorders cause the eye to be more vulnerable to injury and associate with a higher rate of postoperative complications due to the stress added by cataract surgery.…”