Analysis of pathogenic bacteria and predictors of infectious endophthalmitis after cataract surgery

Objective: Postoperative infectious endophthalmitis is a rare but severe complication of cataract surgery that may result in significant visual impairment. This study aimed to investigate pathogenic bacteria distribution, identify risk factors, and evaluate the predictive value of serum inflammatory biomarkers for postoperative infectious endophthalmitis.

Methods: A retrospective observational cohort study was conducted involving 784 patients (1568 eyes) who underwent cataract surgery at Changzhi People’s Hospital Eye Hospital from January 2020 to June 2024. Clinical characteristics of infected and non-infected groups were compared. Aqueous humor and vitreous samples from patients with infectious endophthalmitis were collected for pathogen identification. Serum levels of IL-17, MMP-2, and IGF-1 were measured three days after surgery using ELISA.

Results: Among 784 patients, 42 patients (46 eyes) developed postoperative infectious endophthalmitis. A total of 50 pathogenic strains were isolated. Gram-positive bacteria were the predominant pathogens (73.08%), with Staphylococcus epidermidis (26.92%) and Staphylococcus aureus (19.23%) being the most common. Multivariate logistic regression analysis demonstrated that diabetes mellitus (OR=2.175, 95%CI: 1.308–3.542, P=0.003) and vitreous spillage (OR=3.934, 95%CI: 1.686–9.107, P=0.002) were independent risk factors. Compared with non-infected patients, infected patients showed significantly increased serum IL-17 and MMP-2 levels and decreased IGF-1 levels after surgery. ROC analysis showed that combined detection of IL-17, MMP-2, and IGF-1 achieved excellent predictive performance (AUC=0.955, sensitivity=95.27%, specificity=82.42%).

Conclusion: Diabetes mellitus and vitreous spillage significantly increase the risk of postoperative infectious endophthalmitis after cataract surgery. Gram-positive bacteria remain the dominant pathogens. The combined assessment of IL-17, MMP-2, and IGF-1 may serve as a promising approach for early identification and intervention of high-risk patients.

Wang Feng is an ophthalmologist at Changzhi People’s Hospital Affiliated to Changzhi Medical College. His research interests focus on cataract surgery, postoperative complications, ocular infection, and clinical ophthalmic research. He has participated in clinical studies involving ophthalmic diseases and has experience in cataract surgery management and translational ophthalmology research.