Justin Cooper , 2025-05-02 18:19:00
Key takeaways:
- Posterior capsule rupture was also more likely in these patients.
- Intracameral and topical antibiotic use lowered the risk for postoperative endophthalmitis.
Postoperative endophthalmitis after cataract surgery is more than 17% more likely in patients with diabetes, while posterior capsule rupture during surgery is more than three times as likely, according to a review.
The data also linked significantly lower postoperative endophthalmitis risk, with or without diabetes, to the use of postoperative intracameral and topical antibiotics.
Data derived from Chen KY, et al. J Ophthalmic Inflamm Infect. 2025;doi:10.1186/s12348-025-00483-9.
Postoperative endophthalmitis is one of the most serious complications of cataract surgery and “can lead to severe visual impairment or even blindness,” Kai-Yang Chen, of the School of Medicine at Taipei Medical University, Taiwan, and colleagues wrote in the Journal of Ophthalmic Inflammation and Infection.
“Diabetes mellitus is a recognized risk factor for [postoperative endophthalmitis] due to its association with delayed wound healing, heightened inflammatory responses and compromised immunity,” they said. “Given the increasing frequency of cataract surgeries in this population, a thorough evaluation of risk factors and outcomes is crucial to improving perioperative care and reducing complications.”
Chen and colleagues conducted a systematic review of nine studies with data on cataract surgeries in people with diabetes, seven of which were also included in a meta-analysis. They used random effects models to calculate pooled odds ratios for postoperative endophthalmitis and posterior capsule rupture (PCR).
Overall, patients with diabetes undergoing cataract surgery were 17.4% more likely to develop postoperative endophthalmitis (pooled OR = 1.174; 95% CI, 1.109-1.242) than those without diabetes, with an incidence rate of 0.261% vs. 0.242%. PCR was more than three times as likely (pooled OR = 3.434; 95% CI, 1.789-6.591) in patients with diabetes.
“The increased PCR risk in people with diabetes may be attributed to factors such as altered lens anatomy and the greater prevalence of comorbidities that complicate surgery,” the researchers wrote. “Consequently, PCR in people with diabetes may amplify the risk of [postoperative endophthalmitis], as the rupture creates a pathway for microbial entry, heightening the infection risk.”
A pooled analysis of three studies revealed that the use of postoperative intracameral and topical antibiotics significantly decreased the risk for postoperative endophthalmitis, regardless of diabetes status (OR = 0.231; 95% CI, 0.134-0.399).
Individual studies also reported significantly increased risk for postoperative endophthalmitis in patients with diabetes who were men (OR = 1.634; P = .048) or had hypertension (OR = 3.961; P < .001).
“Our study indicates that for people with diabetes undergoing cataract surgery, it is crucial to maintain well-controlled blood sugar and blood pressure beforehand,” Chen and colleagues wrote. “During surgery, extra caution should be taken to prevent PCR, and appropriate antibiotic use should be considered to minimize the risk of [postoperative endophthalmitis].”
