Endophthalmitis After Cataract Surgery in the US, A Report from the IRIS Registry, 2013-2017

Abstract Objective To determine recent incidence and visual outcomes for acute-onset endophthalmitis after cataract surgery performed in the United States (US) Design Retrospective cohort study Participants 5,401,686 patients undergoing cataract surgery in the US between 2013 and 2017 Methods Acute-onset postoperative endophthalmitis cases occurring within 30 days after cataract surgery were identified using diagnosis codes in the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) database, drawn from electronic health records in ophthalmology practices across the US. Annual and aggregate 5-year incidence was determined for all cataract surgeries, and specifically for standalone procedures versus combined with other ophthalmic surgeries. Patient characteristics were compared, and mean and median visual acuity was determined at 1 month preoperative as well as 1 week, 1 month, and 3 months postoperative among patients with and without endophthalmitis. Main Outcome Measures Incidence of acute-onset postoperative endophthalmitis after cataract surgery Results 8,542,838 eyes underwent cataract surgery, 3629 of which developed acute-onset endophthalmitis (0.04%; 95% CI 0.04-0.04%). Incidence of endophthalmitis was highest among patients aged 0-17 years (0.37% over 5 years), followed by patients aged 18-44 years (0.18% over 5 years) (p Conclusions Acute-onset endophthalmitis occurred in 0.04% of 8,542,838 real-world cataract surgeries performed in the United States between 2013 and 2017. Risk factors may include younger age, undergoing cataract surgery combined with other ophthalmic surgeries, and anterior vitrectomy. Visual acuity outcomes vary; however, patients can recover excellent vision after surgery. Big data from clinical registries such as the IRIS Registry has great potential for evaluating rare conditions such as endophthalmitis, including developing benchmarks, longer-term investigation of trends over time, and comprehensive analysis of risk factors and prophylaxis.