Endophthalmitis Rate Post-PPV Found to Be Low

Patients aged 85 years or older were more likely to develop postoperative endophthalmitis following pars plana vitrectomy in this study compared to those aged 65 to 74 years. Photo: Wikimedia Commons/Journal of Ophthalmology, Liu X et al. Click image to enlarge. Pars plana vitrectomy (PPV) is currently the most common surgical approach to retinal diseases such as retinal detachments (RDs), epiretinal membranes and macular holes. Microinvasive vitrectomy surgery is now the most used surgical PPV technique, and most data on postoperative endophthalmitis rates following this procedure are derived from single-centers or a survey-based multicenter study. Researchers from Johns Hopkins University School of Medicine recently analyzed the incidence of endophthalmitis among Medicare beneficiaries undergoing retina surgery and assessed patient-related risk factors for developing endophthalmitis. They determined that endophthalmitis rates following PPV were low. Older age (≥85 years), complex RD repair and macular surgery were identified as risk factors for developing endophthalmitis. Also, concurrent cataract surgery was associated with a decreased postoperative endophthalmitis risk. Their findings were published in Retina.The researchers performed a retrospective, cross-sectional of Medicare beneficiaries who underwent retina surgery between 2016 and 2022. A two-year look-back period was used to account for eye-related diagnoses and procedures that occurred before the index procedure. To ensure that the index procedure was the first one performed on a given beneficiary, the study excluded individuals who underwent a PPV during the look-back period, as well as patients younger than 67 years old and those with missing demographic information.In this analysis of over 360,000 PPV procedures, the overall 42-day endophthalmitis rate was 0.28%. Endophthalmitis rates following standard RD repair, complex RD repair, macular surgery and other PPV cases were: 0.09%, 0.18%, 0.20% and 0.61%, respectively. Excluding other PPV cases, endophthalmitis occurred in 480 cases for an overall incidence of 0.17%.On multivariable analysis, patients 85 years old and older, Charlson comorbidity index score ≥3, macular surgery and complex RD cases had an increased endophthalmitis risk. The researchers proposed in their paper that “possible reasons for this increased risk include that this population may include patients with diabetes and those with uveitis-related RDs who may be on systemic immunosuppression.”Concurrent cataract surgery was associated with decreased postoperative endophthalmitis risk. The study team hypothesized “this may be secondary to most patients receiving intracameral antibiotics at the end of cataract surgery which may be playing a protective effect. Further studies however are needed to confirm our findings.”This study found no association between any surgeon-related characteristics and endophthalmitis.Click here for the journal source. Zafar S, Dun C, Cai CX, et al. Endophthalmitis after retinal surgery: an eight-year Medicare analysis. Retina. May 30, 2025. [Epub ahead of print].