Endophthalmitis After Retinal Surgery: A 8-Year Medicare Analysis

Purpose:Determine endophthalmitis incidence among Medicare beneficiaries undergoing retina surgery and assess patient and surgeon-related risk factors for developing postoperative endophthalmitis.Methods:Retrospective, cross-sectional of Medicare beneficiaries who underwent retina surgery between 2016 and 2022. Individuals who underwent surgery during the 2-year look-back period, those with an endophthalmitis diagnosis 12 months prior to index procedure, those with any intraocular procedure or intravitreal injection 3 months prior to PPV and missing laterality information were excluded. A multivariable logistic regression model was used to evaluate factors associated with occurrence of postoperative endophthalmitis 42 days following retina surgery.Results:369,471 PPVs were performed among Medicare beneficiaries between 2016-2022. Endophthalmitis occurred in 1,019 cases for an overall incidence of 0.28%. Endophthalmitis rates following standard retinal detachment (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, patient aged ≥85 years, Charlson comorbidity index (CCI) ≥3, macular surgery and complex RD cases had an increased endophthalmitis risk. Concurrent cataract surgery was associated with decreased postoperative endophthalmitis risk. We found no association between surgeon factors and endophthalmitis risk.Conclusion:The overall endophthalmitis rate following retina surgery was 0.28%. Patient age, CCI and PPV indication (complex RD and macular surgery vs. standard RD) were associated with increased endophthalmitis risk. No associations were identified between any surgeon characteristics and postoperative endophthalmitis risk.