Title : Association between immunodeficiency and post operative endophthalmitis after elective cataract surgery: A retrospective case control study
Abstract:
Background: Immunodeficiency is associated with increased susceptibility to infection; however, its role as a potential risk factor for post-operative endophthalmitis (POE) following elective cataract extraction (CE) remains unclear. Current clinical guidelines do not recommend additional prophylactic measures for immunocompromised patients undergoing CE.
Aim: To evaluate whether immunodeficiency increases the risk of developing POE after elective cataract surgery.
Methods: A retrospective case–control study was conducted of all eyes that developed POE following elective CE performed in Portsmouth between 2012 and 2022. Each case was compared with age-matched controls who underwent uncomplicated CE during the same period. Immunodeficiency was defined as any systemic disease or medication known to suppress the immune system within three months preceding surgery.
Results: Among 4,162 cataract operations, seven cases of POE were identified (5 male, 2 female; 4 diabetic; 2 with ocular comorbidities; 2 immunocompromised). Twenty-eight age-matched controls were included (15 male, 13 female; 7 diabetic; 10 with ocular comorbidities; 1 immunocompromised). The odds of developing POE were higher among immunocompromised patients compared with immunocompetent controls (odds ratio = 10.8, 95% CI 0.82–143.2), although this did not reach statistical significance due to the small sample size.
Conclusion: Immunodeficiency may represent a potential risk factor for post-operative endophthalmitis following cataract surgery. While the observed trend suggests increased risk, the wide confidence interval highlights the need for larger multicentre studies to confirm this association and guide perioperative management in immunocompromised patients.
