Uveitis and Immunosuppression Increase Chances of Post-op Inflammation

With more immunosuppressives in development and on the market, and 2.8% of commercially insured adults prescribed these medications, eyecare providers should pay careful attention to the impact these drugs can have on perioperative inflammation, and endophthalmitis specifically. Photo: Joseph Sowka, OD. Click image to enlarge. Endophthalmitis rates have decreased significantly over the last century, thanks to improved surgical techniques and prophylactic measures, but experts say there’s still more to learn about this devastating postoperative complication, particularly in patients on systemic immunosuppressive therapy. A recently published Ophthalmology paper drawing on IRIS Registry data confirmed that the chances of infection are indeed higher in this setting.Researchers focused on uveitis and divided eyes into four groups: Eyes with and without uveitis and no concurrent systemic corticosteroid and/or immunosuppression (Groups B and A, respectively), and eyes with and without uveitis with concurrent systemic corticosteroid and/or immunosuppression (Groups D and C, respectively).They identified more than 9.7 million cataract surgeries performed between 2013 and 2023, where 128,254 of those patients were on systemic corticosteroids and/or immunosuppressive treatment at the time of surgery. The researchers reported that the incidence of acute postoperative endophthalmitis within 60 days of surgery was 0.058%, 0.468%, 0.137% and 0.964% in groups A, B, C and D, respectively. Eyes with uveitis had the highest incidence of endophthalmitis diagnoses, but regardless of uveitis status, endophthalmitis was more common in patients on concurrent systemic corticosteroids and/or immunosuppression. Further analysis showed that systemic corticosteroids were more strongly associated with endophthalmitis than systemic immunosuppressives.“Our study suggests that concurrent systemic corticosteroid and immunosuppressive therapy (and possibly preexisting uveitis diagnosis) may be associated with increased risk of postoperative endophthalmitis following cataract surgery,” the researchers wrote in their Ophthalmology paper. They added that “the risk remains low and the decision to continue such medications perioperatively should be weighed against the risks of immunosuppressive therapy discontinuation such as transplant rejection and flaring up of the underlying systemic autoimmune disease or uveitis.”Click here for the journal source. Ghoraba HH, Haque E, Or C, et al. Incidence of endophthalmitis after cataract surgery in the setting of uveitis and/or immunosuppressive therapy within the IRIS Registry. Ophthalmology 2025. [Epub ahead of print].