Impact of Patient Characteristics and Surgery-Related Risk Factors on Endophthalmitis after Cataract surgery: A Meta-Analysis

Introduction: Cataracts are the leading cause of blindness worldwide, with a notably high incidence rate. Endophthalmitis is the most severe complication following cataract surgery, often resulting in profound vision loss. This study evaluates the impact of risk factors such as age, sex, diabetes mellitus (DM), hypertension, posterior capsule rupture (PCR), type of surgery, and use of intraocular lens (IOL) material on the risk of endophthalmitis after cataract surgery. Methods: English and Chinese public databases were searched from inception to March 1, 2024. We included studies reporting the number of occurrences of endophthalmitis after cataract surgery on potential risk factors, including age, sex, DM status, hypertension status, intraoperative PCR, type of surgery and use of IOL material. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. Results: A total of 57 studies were included and critically evaluated in the meta-analysis. The results showed that female sex was associated with a lower risk of endophthalmitis (odds ratio [OR]: 0.81; 95% CI: 0.75-0.87; p < 0.001). Individuals with diabetes who underwent cataract surgery were found to have a greater risk of endophthalmitis (I-2 = 95%; OR: 4.90; 95% CI: 2.41, 9.95; p < 0.001), but the result may be influenced by publication bias. Individuals with hypertension (OR: 2.88; 95% CI: 1.53, 5.45; p = 0.001) and intraoperative PCR (OR: 9.18; 95% CI: 3.31, 25.43; p < 0.001) were found to have a greater risk of endophthalmitis. Phacoemulsification significantly reduced the risk of endophthalmitis compared with extracapsular cataract extraction (ECCE) (OR: 0.62; 95% CI: 0.45, 0.85) based on network meta-analysis. Conclusion: Male sex, hypertension, intraoperative PCR, and the use of the ECCE surgical approach are associated with a greater risk of postoperative endophthalmitis. Although an age-related trend in elevated risk was observed, this finding should be interpreted cautiously.