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Relationship between anesthesia and postoperative endophthalmitis: A retrospective study.

Hou-Chuan Lai1, Wei-Cheng Tseng, Shu-I Pao

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General anesthesia (GA) and propofol-based total intravenous anesthesia (TIVA) do not increase the risk of endophthalmitis after ocular surgery. Advanced age is a significant risk factor for developing this infection post-operation.

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Area of Science:

  • Ophthalmology
  • Anesthesiology
  • Infectious Disease Epidemiology

Background:

  • Postoperative endophthalmitis is a serious complication following ocular surgery.
  • Nasopharyngeal secretions during general anesthesia (GA), particularly propofol-based total intravenous anesthesia (TIVA), have been suspected as a potential risk factor.
  • Limited comparative data exists on endophthalmitis incidence across different anesthesia techniques in ocular surgery.

Purpose of the Study:

  • To compare the incidence of endophthalmitis after ocular surgery among patients receiving topical anesthesia, inhalation anesthesia, and propofol-based TIVA.
  • To identify risk factors associated with postoperative endophthalmitis in ocular surgery patients.
  • To evaluate the safety of different anesthesia methods regarding endophthalmitis risk.

Main Methods:

  • Retrospective study including 21,032 patients undergoing ocular surgery between 2011 and 2015.
  • Analysis of epidemiologic factors, systemic diseases, ocular characteristics, surgical complications, antibiotic prophylaxis, and anesthesia methods (topical, inhalation, propofol-based TIVA).
  • Comparison of endophthalmitis incidence rates and identification of associated risk factors, including age.

Main Results:

  • The overall incidence of endophthalmitis was 0.071% (15 cases out of 21,032 operations).
  • Incidence rates were 0.083% for topical anesthesia, 0.039% for inhalation anesthesia, and 0% for propofol-based TIVA (P=0.39).
  • General anesthesia (0.024%) showed a significantly lower risk of endophthalmitis compared to topical anesthesia (0.083%) (P<0.001). Advanced age was identified as a risk factor.

Conclusions:

  • Propofol-based TIVA and inhalation anesthesia do not elevate the risk of endophthalmitis after ocular surgery.
  • General anesthesia is not a risk factor for postoperative endophthalmitis; in fact, it may be associated with a lower risk compared to topical anesthesia.
  • Advanced age is a significant risk factor for developing endophthalmitis following ocular surgery.