Diabetes patients at higher risk of developing postoperative endophthalmitis after cataract surgery: Study

Researchers have found in a new study that patients with diabetes undergoing cataract surgery face a significantly higher risk of postoperative complications, including a 17% increased chance of postoperative endophthalmitis (POE) and more than three times the likelihood of posterior capsule rupture. However, the use of intracameral and topical antibiotics has been shown to effectively reduce the risk of endophthalmitis in these patients. This study published in the Journal of Ophthalmic Inflammation and Infection was conducted by Kai-Yang Chen and colleagues.

In order to evaluate the association of diabetes with the risk of POE, a systematic review and meta-analysis of articles until September 10, 2024, based on the data from PubMed, Scopus, Medline, Embase, and Google Scholar were done. Randomized controlled trials and observational studies were included if they compared POE outcomes in cataract surgery patients with individuals with and without diabetes.

Nine studies participated in the systematic review, among which seven were included in the meta-analysis. Researchers used random-effects models for estimating pooled odds ratios (ORs) at 95% confidence intervals (CIs), keeping results into consideration for the variability of study.

Key Findings

General incidence of POE was found to be 0.261% in the diabetic population and 0.242% among non-diabetics.

The combined odds ratio (OR) for POE development among individuals with diabetes was 1.174 (95% CI: 1.109 to 1.242; p = 0.000), validating significantly increased risk.

Men with diabetes were at increased risk as well, OR = 1.634 (p = 0.048).

It was significantly greater among those who had diabetes along with hypertension with an OR = 3.961 (p < 0.001).

Posterior capsule rupture (PCR) is an intraoperative complication of known etiology, more frequently observed in patients with diabetes, and its incidence was correlated with an OR of 3.434 (95% CI: 1.789 to 6.591; p = 0.0001) for POE.

Reduction in risk of POE among all the patients significantly associated with postoperative intracameral and topical application of antibiotics had an OR of 0.231 (p = 0.000), proving prophylactic antibiotic therapy as the best defense.

This meta-analysis reaffirms that individuals with diabetes who undergo cataract surgery have a considerably higher risk of developing postoperative endophthalmitis and posterior capsule rupture. The risk is further enhanced in males and patients with co-existing hypertension. Significantly, the study also illustrates that prophylactic antibiotic treatment markedly decreases POE risk in all patients.

Reference:

Chen, KY., Chan, HC. & Chan, CM. Do people with diabetes have a higher risk of developing postoperative endophthalmitis after cataract surgery? A systematic review and meta-analysis. J Ophthal Inflamm Infect 15, 24 (2025). https://doi.org/10.1186/s12348-025-00483-9