Preoperative Glycemic Control and Acute Endophthalmitis after Cataract Surgery in United States Veterans with Diabetes Mellitus

Abstract

Purpose:

To evaluate whether preoperative glycemic control is predictive of acute endophthalmitis after cataract surgery.

Design:

Retrospective case-control study.

Participants:

Patients with diabetes mellitus (DM) who underwent cataract surgery from 2010 through 2022 in the United States 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 preoperative hemoglobin A1c (HbA1c) levels drawn 0 to 6 months before surgery. Patients with acute postoperative endophthalmitis 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 preoperative HbA1c and the development of postoperative endophthalmitis.

Main Outcome Measures:

Development of postoperative 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 to 6 months before surgery, 157 patients (0.08%) demonstrated acute postoperative endophthalmitis. Mean ± standard deviation preoperative HbA1c was lower in patients with acute postoperative endophthalmitis (7.1 ± 1.4%) than in control participants 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 to 2 months before surgery showed no association between preoperative HbA1c and endophthalmitis (P = 0.31). Multiple logistic regression analysis also showed no association between preoperative glycemic control as measured by HbA1c and postoperative endophthalmitis (adjusted odds ratio, 0.89; 95% confidence interval, 0.79–1.01; P = 0.08).

Conclusions:

Preoperative HbA1c level was not associated with the development of acute postoperative endophthalmitis in patients with DM undergoing cataract surgery. These findings suggest that preoperative HbA1c guidelines based on infection rates after nonophthalmic surgery may not apply to cataract surgery.

Financial Disclosure(s):

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.