Epidemiology of acute endophthalmitis after intraocular procedures: a national database study

OBJECTIVE: To describe the causes of postoperative acute endophthalmitis at a national scale longitudinally. DESIGN: Cohort study from 2009 to 2018 in France. PARTICIPANTS: Patients diagnosed with acute endophthalmitis following intraocular procedures. METHODS: The French Medical-Administrative Database was used, endophthalmitis cases and intraocular procedures were identified by means of billing codes in all French hospitals and private practices. Main Outcomes and Measures: Incidence of acute endophthalmitis within 42 days of the procedure. RESULTS: From January 1, 2009 to October 31, 2018, 7522 cases of acute endophthalmitis occurred following 14 438 854 intraocular procedures. Most cases occurred after standalone cataract surgery (4808 cases for 7 316 077 procedures, 63.92%), followed by IVTs (1 296 cases for 5 455 631 IVTs, 17.23%), vitreoretinal surgery (698 for 442 263 procedures, 9.28%), anterior segment surgery (245 cases, 3.26%), combined cataract and vitreoretinal surgery (191 cases, 2.54%), cornea surgery (142 cases, 1.89%), and glaucoma surgery (80 cases, 1.06%). The overall incidence of acute endophthalmitis was 1 per 1920 procedures (0.0521% procedures, 95% CI, 0.0520-0.0522). The surgeries with the highest incidence of endophthalmitis were the scleral and globe surgery group, 0.1827% (95% CI, 0.1757-0.1898), followed by vitreoretinal surgery combined with cataract surgery, 0.1685% (95% CI, 0.1663-0.1706). The incidence of endophthalmitis after IVTs was stable over the study-period and patients were the oldest, 75.4 years (SD±12.0), P < 0.001. The onset of endophthalmitis following intravitreal procedures, after IVTs and vitreoretinal surgery, was shorter than for other procedures (P < 0.001). CONCLUSIONS: The profile of patients referred for acute endophthalmitis has been evolving over a decade, with a decrease in the raw number of endophthalmitis cases after cataract surgery as opposed to an increase in the number of patients presenting with endophthalmitis after IVTs