Is combined cataract surgery associated with acute postoperative endophthalmitis? A nationwide study from 2005 to 2014

Purpose To assess the incidence of acute postoperative endophthalmitis (POE) after cataract surgery combined with corneal, glaucoma or vitreoretinal surgical procedures from 2005 to 2014 in France. Methods In this cohort study, acute POE occurring within 6 weeks after surgery was identified by means of billing codes recorded in a national database in patients operated for cataract extraction with phacoemulsification, or corneal, glaucoma or vitreoretinal surgical procedures, either combined or stand-alone. Results From January 2005 to December 2014, up to 6 260 477 eyes underwent phacoemulsification cataract surgery as a single procedure and 115 468 eyes underwent phacoemulsification combined with corneal, glaucoma or vitreoretinal surgical procedures. The crude incidence of acute POE after stand-alone or combined cataract surgery was 0.102% and 0.149%, respectively. In multivariate Poisson analysis, combined surgery taken as a whole was at higher risk than cataract stand-alone surgery, with an adjusted incidence rate ratio (IRR) (95% CI) of 1.38 (1.11 to 1.70; p= 0.0054). Glaucoma surgeries were associated with a lower acute POE incidence compared with phacoemulsification, conversely to vitreoretinal surgical procedures: IRR 0.63 (0.47 to 0.85; p< 0.001) and IRR 1.78 (1.58 to 2.01; p< 0.001), respectively. Conclusion A higher incidence of acute POE after combined cataract surgery than after cataract surgery done as a stand-alone procedure was observed based on the French nationwide medical-administrative database. The incidence of acute POE after combined surgery was related to the type of surgery performed simultaneously with cataract extraction.