Endophthalmitis Rates in Cataract Surgery Associated with Uveitis and/or Immunosuppressive therapy within the IRIS® Registry
Hashem Ghoraba, Md Enamul Haque, Chi Mong C Or, Gina Yu, Quan Dong Nguyen, Suzann Pershing
Byers Eye Institute at Stanford University.
Purpose: To determine rates of postoperative endophthalmitis after cataract surgery associated with uveitis and/or immunosuppressive therapy using the American Academy of Ophthalmology Intelligent Research in Sight (IRIS®) Registry database.
Methods: The Intelligent Research in Sight (IRIS®) registry was queried for cases that underwent cataract surgery between Jan 1, 2013 and Dec 31, 2018. IRIS® database version was Rome 2 and the data were frozen on 7/28/2020. Postoperative endophthalmitis was identified based on International Classification of Diseases (ICD) codes 9/10 for endophthalmitis and/or tap and intravitreal antibiotic injection within 60 days after surgery. Cases with a recent non-infectious uveitis diagnosis within 1 year prior to cataract surgery were also identified. Active use of systemic steroids and/or immunosuppressives was determined using drug names and the National Library of Medicine Rx Concept Unique identifier (RxCUI).
Patients who underwent cataract surgery were classified into 4 groups: A: patients with no uveitis and no concurrent systemic steroid or immunosuppressive treatment (general population), B: patients with recent uveitis and no concurrent systemic steroid or immunosuppressive treatment, C: patients with no uveitis and with concurrent systemic steroid and/or immunosuppressive treatment and D: patients with recent uveitis and concurrent systemic steroid and/or immunosuppressive treatment.
Results: 6,963,264 patients were identified to have had cataract surgery, of those, 90,905 patients were on systemic steroids and/or immunosuppressives at the time of surgery. Regardless of the diagnosis, incidence of postoperative endophthalmitis was higher in patients on immunosuppressives and/or steroids than those who are not. Furthermore, the incidence of postoperative endophthalmitis was 0.049%, 0.385%, 0.103% and 1.218%, in groups A, B, C and D, respectively. Multivariate logistic regression analysis revealed that systemic steroids were more associated with postoperative endophthalmitis compared with systemic immunosuppressives.
Conclusion: Systemic steroids and immunosuppressives increase the risk of endophthalmitis following cataract surgery.