Epidemiology of acute endophthalmitis after ophthalmological procedures, a national database description

International audiencePurpose : Although rare, endophthalmitis is a severe complication of ophthalmological procedures. The incidence of endophthalmitis following cataract, glaucoma, vitreoretinal surgeries, and intravitreal injections has previously been described in large-scale studies, but no data is available on the proportion of causative procedures. We aimed to describe longitudinally the causes of endophthalmitis at a national scale using the French medico-administrative database.Methods : The SNIIRAM (French national inter-scheme insurance database) collects all data of medical expenditures and procedures performed in France. We extracted acute endophthalmitis occurring 42 days after an ophthalmological procedure, by means of hospital discharge code (CIM10 H440, H441) and procedures codes from 2009 to 2018.Results : From 2009 to 2018, 7 776 acute endophthalmitis followed ophthalmological procedures, in 7 754 patients. Age at diagnosis was 71.7 ± 12.9 years) and 51.02% of the patients were women. Most endophthalmitis were caused by non-combined cataract surgery (4 957 cases, 63.75%), followed by IVTs (1 392, 17.90%), vitreoretinal surgery (761, 9.79%), anterior segment surgery (226, 2.91%), combined cataract and vitreoretinal surgery (154, 1.98%), cornea surgery (131, 1.68%), glaucoma surgery (84, 1.08%). The frequency of causative procedures remained stable over the years for all procedures except for cataract surgery which decreased from 2009 (763, 79.98% of the year’s etiologies) to 2018 (432, 51.92%) with a rapid decrease in 2012, and for IVT which increased in the same time period (from 70, 7.34% to 258, 31.01%). Patients with acute endophthalmitis following IVTs were the oldest (75.2 ± 12.3 years old), Endophthalmitis following Intravitreal procedures, IVTs, and vitreoretinal surgeries occurred sooner than after other procedures (median (IQR); 4.0 days (3.0-7.0) and 4.0 (2.0-8.0), respectively) versus 6.0 days (4.0-11.0) days in cataract surgery.Conclusions : We observe that in more than 1.3 million ophthalmological procedures per year in France, the occurrence of acute endophthalmitis is low. This data shows a shift in causative factors with a decrease of endophthalmitis following cataract surgery and an increasing number after IVT