Epidemiology of Acute Endophthalmitis after Intraocular Procedures: A National Database Study

Ophthalmol Retina. 2022 Jun;6(6):442-449. doi: 10.1016/j.oret.2022.01.022. Epub 2022 Feb 5.


Objective: To describe the causes of postoperative acute endophthalmitis at the national level longitudinally.

Design: Cohort study from 2009 to 2018 in France.

Participants: Patients diagnosed with acute endophthalmitis after intraocular procedures.

Methods: The French medical-administrative database was used. Endophthalmitis cases and intraocular procedures were identified based on billing codes in all French hospitals and private practices.

Main outcome measures: The 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 after 14 438 854 intraocular procedures. Most cases occurred after standalone cataract surgery (4808 cases for 7 316 077 procedures; 63.92%), followed by after intravitreal (IVT) injections (1296 cases for 5 455 631 IVT injections; 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%; 95% confidence interval [CI], 0.0520-0.0522). The surgery with the highest incidence of endophthalmitis was scleral and globe surgery, with an incidence of 0.1827% (95% CI, 0.1757-0.1898), followed by vitreoretinal surgery combined with cataract surgery, with an incidence of 0.1685% (95% CI, 0.1663-0.1706). The incidence of endophthalmitis after IVT injections was stable over the study period, and patients receiving IVT injections were the oldest, aged 75.4 years (standard deviation, 12.0 years; P < 0.001). The onset of endophthalmitis after IVT procedures, i.e, after receiving IVT injections or undergoing vitreoretinal surgery, was earlier than that after the other procedures (P < 0.001).

Conclusions: The profile of patients referred for acute endophthalmitis has been evolving over the past 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 IVT injections.

Keywords: Endophthalmitis; Epidemiology; National database.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Cataract Extraction* / adverse effects
  • Cataract* / complications
  • Cohort Studies
  • Endophthalmitis* / diagnosis
  • Endophthalmitis* / epidemiology
  • Endophthalmitis* / etiology
  • Humans
  • Postoperative Complications / epidemiology
  • Retrospective Studies