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Postop endophthalmitis rates fairly stable after cataract surgeries, corneal transplants
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Postoperative endophthalmitis after corneal transplant or cataract surgery is rare, although rates are slightly higher after corneal transplant, according to a claims-based study.
The retrospective population-based cohort study based on Medicare claims data included patients who underwent corneal transplants (18,083), cataract surgeries (2,261,779) or both on the same day (3,705) from July 1, 2006, to Aug. 31, 2011.
Endophthalmitis rates were analyzed at intervals of 6 weeks and 6 months after surgery using a sensitive definition based on ICD-9 codes, a specific definition based on ICD-9 and CPT-4 codes, and a fungal definition based on ICD-9 codes and claims for antifungal medication.
The corneal transplant cohort had the highest incidence of endophthalmitis in all definitions.
Rates of sensitive endophthalmitis were more than three times higher in the corneal transplant group than in the cataract surgery group at 6 weeks and more than five times higher at 6 months; for specific endophthalmitis, rates were twice as high at 6 weeks and four times as high at 6 months.
Rates of fungal endophthalmitis infection were also higher than in the cataract surgery cohort.
Male sex, socioeconomic status and immunosuppressant use correlated with higher risk for endophthalmitis after index surgeries.
Disclosure: The authors have no relevant financial disclosures.
Perspective
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Francis W. Price Jr., MD
This study uses a number of flawed methods to detect rates of endophthalmitis in Medicare patients.
The authors analyzed data of patients participating in Medicare Part A, B and D from 2006 to 2011 to determine the incidence of endophthalmitis after corneal transplants and cataract surgery. They determined the incidence three ways: using claims for the exact codes for endophthalmitis, claims for related surgeries (vitrectomy or intraocular injections) and claims for antifungal medications that occurred within either 6 weeks or 6 months after surgery. They noted that the incidence of fungal infections was too small to be conclusive.
They found the incidence of endophthalmitis was similar for cataract surgery but was higher for corneal transplant surgeries than prior reports and speculated that the movement of transplants from a hospital setting to an outpatient setting was responsible for the increase — an erroneous conclusion on multiple levels because of the increased risk of exposure to pathogens in hospital settings. Looking at endophthalmitis out to 6 months in corneal transplant patients will include suture and ocular surface disease — causes of infection not directly related to surgery. Including postoperative intraocular injections as an indicator of endophthalmitis in the age of macular degeneration treatment is a huge confounder.
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