Endophthalmitis After Cataract Surgery: An Update on Recent Advances

Travis J. Peck; Samir N. Patel; Allen C. Ho


Curr Opin Ophthalmol. 2021;32(1):62-68. 

In This Article


Rates of endophthalmitis in the United States increased from approximately 0.12% in the 1980s[1] to a peak of 0.24% in 2000,[2] prior to decreasing to 0.11% in 2004.[3] The increase in the 1990s was likely related to the implementation of clear corneal incisions, among other factors.[2] Various improvements in surgical and medical technique have led to a continued decrease over the past decade. The Intelligent Research for Sight (IRIS) registry, collected from 2013 to 2017 in the United States, found an endophthalmitis rate of 0.04% within 30 days of cataract surgery.[4] These findings are consistent with a rate of approximately 0.05% in recent large studies in France, South Korea, and Poland.[5–7] The studies in France and Poland both found that rates dropped significantly from the beginning of the studies in 2007 and 2010, respectively, to the conclusion of the studies in 2014 and 2015, respectively.[5,6]

Rates of endophthalmitis are affected by both surgical and demographic factors. The IRIS registry noted a fivefold increased rate of endophthalmitis in patients undergoing cataract surgery combined with other surgeries.[4] Furthermore, the use of anterior vitrectomy was associated with the greatest increase in endophthalmitis risk, but a significant increase was also noted when cataract surgery was combined with glaucoma procedures.[4] In contrast, a large review from France found a lower rate of endophthalmitis in combined cataract and glaucoma surgery than in cataract surgery alone.[6] It seems logical that combined procedures would increase risk for endophthalmitis because of additional incisions, which provide a potential entry for pathogens, and longer operative time, which has been identified as a risk factor.[8]

Older age has previously been shown to be a risk factor for developing endophthalmitis,[9,10] but there was not an increased rate of endophthalmitis in patients 85 years of age or older compared with patients aged 64–85-years-old in the IRIS registry.[4] This is surprising as decreased healing and difficulty with medication administration, among other factors, would seem to put this population at risk. Age was found to have a significant effect on the rate of endophthalmitis, but it was patients under 45 years of age who were at increased risk, and those under 18 years of age who were at the greatest risk.[4] The higher incidence of endophthalmitis in young patients is partially the result of the increased complexity of these surgeries with higher rates of complications and anterior vitrectomies.[4]