Seventeen million procedures give an endophthalmitis rate for every operation you do

Design

retrospective cohort study using a national ophthalmic registry

Population

17,457,881 ophthalmic procedures in adults and children, 2016-2024

Primary outcome

incidence of acute endophthalmitis within 30 days of surgery

Effect

adults: open globe repair 0.94%, vitrectomy for detachment 0.097%, trabeculectomy 0.1%, cataract surgery 0.038%, strabismus 0.011%; children: cataract surgery 0.11% (P=0.014 against adults), scleral buckle 0.415%

A national ophthalmic registry analysis covered 17,457,881 procedures performed between 2016 and 2024, counting acute endophthalmitis diagnosed within 30 days.

In adults, open globe repair dominated at 0.94% - one case per 106 procedures. Then vitrectomy for retinal detachment at 0.097% (1 in 1,031), trabeculectomy at 0.1% (1 in 1,000), tube shunts at 0.075% (1 in 1,333), scleral buckle at 0.068% (1 in 1,459), cataract surgery at 0.038% (1 in 2,652), standalone minimally invasive glaucoma surgery at 0.039% (1 in 2,551), goniotomy at 0.02% (1 in 5,013) and strabismus surgery at 0.011% (1 in 9,091). Two comparisons answer live questions: minimally invasive glaucoma surgery carried essentially the same risk as cataract surgery alone, and combining cataract with glaucoma surgery on the same day did not raise the rate above glaucoma surgery alone.

Children were different, and this is the finding that should change something. Paediatric cataract surgery carried an endophthalmitis rate of 0.11% - one in 871, about three times the adult rate (P=0.014). Paediatric scleral buckle was 0.415%, one in 675. Open globe repair in children was 0.87%, similar to adults. The registry is American, with its own case mix and coding practices, and a 30-day window captures acute but not delayed-onset disease. Even so, these are the most solid per-procedure figures available, and they are precise enough to quote at consent and to benchmark your own unit against.

• Quote the procedure-specific rate at consent rather than a general statement about infection
• Use a higher figure when consenting for paediatric cataract surgery - about one in 871 against one in 2,652 in adults
• Do not treat adding minimally invasive glaucoma surgery to cataract surgery as raising infection risk; it did not
• Benchmark your own unit's rate against these figures; a persistently higher rate is a signal to review theatre practice
• Remember the 30-day window - delayed-onset endophthalmitis is not captured here and is a separate problem

Why it matters

It converts a vague consent sentence into a specific number, per operation and per age group.

Don't overread it

A US registry with its own case mix and coding practice, capturing only acute endophthalmitis within 30 days - it is not a trial, and delayed-onset disease is excluded.

The statistics, in plain English

With 17 million procedures, even the rarer operations have enough events for stable estimates, which is what makes these figures quotable in a way that single-centre series never are. The paediatric cataract comparison (P=0.014) rests on far fewer cases, so the threefold difference is real but its size is less certain. Two null results are worth reading as reassurance rather than as absence of data: minimally invasive glaucoma surgery matching cataract surgery, and same-day combined surgery matching glaucoma surgery alone, are both based on large numbers.

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