Postoperative Endophthalmitis in Immediate Sequential Bilateral Cataract Surgery

May 2022

Written by: Phillip Storey, MD
Austin Retina Associates
Austin, TX

Friling E, Johansson B, Londsteom M, et al. Postoperative endophthalmitis in immediate sequential bilateral cataract surgery: a nationwide registry study.Ophthalmology. 2022;129(1):26-34. Lacy M, Kung T, Owens J, et al. Endophthalmitis rate in immediately sequential versus delayed sequential bilateral cataract surgery within the IRIS registry data. Ophthalmology. 2022;129(2):129-38.

Post-surgical endophthalmitis remains one of the most feared complications of cataract surgery. Historically, most cataract surgeons have generally waited a week or more after cataract surgery on one eye before proceeding with surgery on the contralateral eye, in part to avoid the possibility of bilateral endophthalmitis. However, recovery from cataract surgery can be a burden for patients, many of whom may prefer to recover from surgery on both eyes during the same time period. Same day bilateral cataract surgery has become more widely practiced over the last decade. Recently, two publications explored the risk of postoperative endophthalmitis following immediate sequential bilateral cataract surgery. 

In a study of the Swedish National Cataract Registry over a 16-year period, 422 cases of postoperative endophthalmitis following 1,457,172 cataract surgery were identified. Immediate sequential bilateral cataract surgery was performed in 92,238 operations with endophthalmitis occurring after 14 cases giving a rate of 0.0152%. Unilateral cataract surgery resulted in an endophthalmitis rate of 0.0299%, which reached statistical significance for a higher rate of infection (p=0.01). Following same day bilateral surgery, one 93-year-old patient developed bilateral infection.

In a study of the American Academy of Ophthalmology Intelligent Research in Sight (IRIS) Registry database, 3,102 cases of endophthalmitis following 5,573,639 cataract surgeries were identified. A total of 165,609 patients underwent immediate sequential bilateral cataract surgery. Rates of endophthalmitis were similar between the two groups (0.059% unilateral surgery vs. 0.056% bilateral immediate surgery, p=0.53). Seven cases of endophthalmitis in the bilateral surgery group were identified.

Same day bilateral endophthalmitis remains a complication that arises in a small proportion of the total patients undergoing cataract surgery in both Sweden and the United States. Rates of endophthalmitis remain low with similar risk following unilateral or same day bilateral surgery. Surgeons can reasonably offer patients same day cataract surgery, although bilateral endophthalmitis following surgery remains a risk.