Risk of acute-onset postoperative endophthalmitis following ophthalmologic surgery

Background Ophthalmic surgery is generally safe; however, acute-onset postoperative endophthalmitis is a rare complication that can lead to devastating vision loss. This study aims to calculate the incidence of acute-onset postoperative endophthalmitis across various ophthalmic procedures and perform a comparative analysis on relative risk (RR) between surgeries.Research design and methods A retrospective cohort study using the TriNetX US Research Network. Adults who underwent ocular surgery between 2005 and 2025 were identified by CPT codes. The primary outcome was acute-onset postoperative endophthalmitis by CPT or ICD10 codes within 6 weeks. Propensity score matching was performed using routine cataract surgery as a reference group.Results The study included 1,080,935 ocular surgeries. The overall incidence of acute-onset endophthalmitis was 0.096% (1 in 1040). Cataract surgery had the lowest incidence (0.054%), followed by trabeculectomy (0.062%), combined cataract/MIGS (0.068%), complex cataract (0.106%), corneal transplantation (0.107%), GDI (0.117%), RD surgery (0.175%), and secondary IOL implantation (0.520%). RR was similar for MIGS and trabeculectomy, but higher for complex cataract, GDI, corneal transplantation, RD surgery, and secondary IOLs.Conclusions Acute-onset postoperative endophthalmitis is a rare complication of ophthalmic surgery. Routine cataract surgery was found to have the lowest risk whereas secondary IOL implantation had the highest.