Pre-Operative Glycemic Control and Acute Endophthalmitis after Cataract Surgery in US Veterans with Diabetes Mellitus.

Abstract

Purpose: To evaluate whether pre-operative glycemic control is predictive of acute endophthalmitis after cataract surgery.

Design: Retrospective case-control study.

Subjects: Patients with diabetes mellitus (DM) who underwent cataract surgery in 2010-2022 in the US Veterans Affairs (VA) Health Care System.

Methods: Data extracted from the VA Corporate Data Warehouse included patient demographics, clinical features, timing of DM diagnosis, and pre-operative hemoglobin A1c (HbA1c) levels drawn 0-6 months before surgery. Acute post-operative endophthalmitis cases were identified using Current Procedural Terminology and International Classification of Diseases codes, then confirmed by chart review. Univariable and multivariable analyses were used to test for an association between pre-operative HbA1c and the development of post-operative endophthalmitis.

Main outcome measures: Development of post-operative endophthalmitis within 42 days after cataract surgery.

Results: Of 190 393 patients with a diagnosis of DM at the time of cataract surgery and HbA1c recorded 0-6 months prior to surgery, 157 (0.08%) developed acute post-operative endophthalmitis. Mean ± standard deviation pre-operative HbA1c was lower in patients with acute post-operative endophthalmitis (7.1 ± 1.4%) than in controls without endophthalmitis (7.3 ± 1.5%) but this difference was not significant (P = 0.14). Similarly, subanalysis of the cohort with HbA1c levels drawn 0-2 months before surgery showed no association between pre-operative HbA1c and endophthalmitis (P = 0.31). Multiple logistic regression analysis also showed no association between pre-operative glycemic control as measured by HbA1c and post-operative endophthalmitis (adjusted odds ratio, 0.89; 95% confidence interval, 0.79 - 1.01; P = 0.08).

Conclusions: Pre-operative HbA1c level was not associated with the development of acute post-operative endophthalmitis in patients with DM undergoing cataract surgery. These findings suggest that pre-operative HbA1c guidelines based on infection rates after non-ophthalmic surgery may not apply to cataract surgery.