Comparative Endophthalmitis Rates in Adult and Pediatric Patients across Various Ophthalmic Procedures

Purpose To evaluate the incidence of endophthalmitis after ophthalmic surgery using a national ophthalmic registry. Design Retrospective clinical cohort study. Participants Patients in the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) who underwent ophthalmic surgeries were included in this analysis. Main Outcome Measure Incidence of endophthalmitis during the first 30 days after surgery. Methods Pediatric and adult patients in the IRIS® Registry with a diagnosis of acute endophthalmitis within 30 days after surgery from 2016 through 2024. Results The study analyzed 17 457 881 procedures. Rates of endophthalmitis varied by procedure. Among adults, the highest incidence occurred after open-globe repair (0.94%; 1 case per 106 procedures). The incidence of endophthalmitis was 0.097% (1 case per 1031 procedures) after vitrectomy for retinal detachment, 0.1% for trabeculectomy (1 case per 1000 procedures), 0.075% for tube shunts (1 case per 1333 procedures), and 0.068% for scleral buckle surgery (1 case per 1459 procedures). The incidence after cataract surgery was 0.038% (1 case per 2652 procedures), 0.039% (1 case per 2551 procedures) after standalone minimally invasive glaucoma surgery, 0.02% (1 case per 5013 procedures) after goniotomy, and 0.011% for strabismus surgery (1 case per 9091 procedures). Among pediatric patients, the incidence of endophthalmitis after open-globe repair was 0.87% (1 case per 115 procedures). The incidence of endophthalmitis was 0.415% (1 case per 675 procedures) after scleral buckle surgery, 0.11% (1 case per 871 procedures) after cataract surgery, 0.084% (1 case per 1190 procedures) after vitrectomy for retinal detachment, and 0.0072% (1 case per 13 884 procedures) after strabismus surgery. The risk of endophthalmitis was significantly higher for pediatric vs. adult patients after cataract surgery ( P = 0.014). Endophthalmitis rates after same-date cataract and glaucoma surgery vs. glaucoma surgery alone did not differ significantly. Conclusions Rates of endophthalmitis after ophthalmic surgical procedures are variable, with the highest incidence being open-globe repair. Minimally invasive glaucoma surgery procedures showed comparable infection rates as standard cataract surgery. A higher rate of infection after cataract surgery occurred in pediatric patients when compared with adults. Financial Disclosure(s) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.