Diabetes, Vitreous Spillage Elevate Risk of Infectious Endophthalmitis Post-Cataract Surgery

Combining the three biomarkers of elevated IL-17, elevated MMP-2 and decreased IGF-1 serum values exhibited high predictive value for infectious endophthalmitis after cataract surgery, indicating their potential role in early clinical intervention and risk stratification. Photo: Joseph Sowka, OD. Click image to enlarge. Postoperative infectious endophthalmitis may only occur rarely (0.03% to 0.11% of cataract surgeries) but its effects can be devastating. It is influenced by several risk factors, including age, diabetes status and surgical duration. The primary causative agents are Gram-positive bacteria, such as Staphylococcus epidermidis and Staphylococcus aureus, and the growing issue of bacterial resistance further complicates treatment options. A recent study sought to explore these risk factors, the distribution of pathogens and relevant biomarkers to potentially improve early detection of this sight-threatening complication. Their findings, published last Friday in BMC Ophthalmology, are described below. Included in the retrospective observational cohort study were 784 patients (1,568 eyes) who underwent cataract surgery at a hospital in China over a four-year period. Among the enrolled patients, 42 were diagnosed with endophthalmitis, accounting for 46 affected eyes, with 73.1% of isolated pathogens being Gram-positive bacteria, notably Staph epi and aureus.Two independent risk factors were identified in the multivariate analysis: diabetes mellitus (odds ratio: 2.18) and vitreous spillage (odds ratio: 3.93). The researchers elaborated on these associations in their paper, noting that diabetes patients “often suffer from impaired immune function due to chronic hyperglycemia,” an environment that “provides a favorable condition for bacterial proliferation, increasing the susceptibility to infection.” As for vitreous spillage, they noted that this risk factor “may indicate intraocular vascular injury, disrupting the ocular barrier function, and subsequently triggering an inflammatory stress response, thereby exacerbating the development of infectious endophthalmitis.” It’s also possible that spillage occurring earlier in the procedure may pose a greater risk, as it prolongs the vitreous cavity's exposure to potential contaminants; however, the researchers were unable to test this hypothesis due to absent data on when spillage occurred during surgery in infected patients.The study also revealed that serum levels of IL-17 and MMP-2 were significantly elevated in infected patients, while IGF-1 levels were notably decreased. The combined detection of these biomarkers demonstrated a high predictive efficacy with an area under the curve of 0.955, a sensitivity of 95.3% and a specificity of 82.4%, which the authors note “suggests that measuring these biomarkers on the third postoperative day, before the full clinical manifestation of endophthalmitis, could serve as a valuable tool for early risk stratification.”However, the researchers point out that the adoption of this screening strategy in standard ophthalmic practice may face hurdles such as the cost-effectiveness of routine testing, the necessity of standardized assays and the timely accessibility of results. Moreover, these findings must be validated through an independent, prospective multicenter study prior to clinical adoption, they added.“To gain a deeper understanding of the pathogenesis and to improve preventive and therapeutic strategies for postoperative infectious endophthalmitis, further research is essential to explore novel biomarkers, optimize antimicrobial usage and consider the specificities of different healthcare environments and patient populations,” the study concluded.Click here for the journal source. Hui W, Hui L, Junfeng P, et al. Analysis of pathogenic bacteria and predictors of infectious endophthalmitis after cataract surgery. BMC Ophthalmology. 2025;25:613.This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.