Managing Cutibacterium acnes endophthalmitis after cataract surgery: A systematic review and meta-analysis

Cutibacterium acnes endophthalmitis is a subtle, indolent infection that typically follows cataract extraction with intraocular lens implantation. Ill-defined symptoms, false-negative cultures, and uncoordinated surgical interventions contribute to a prolonged disease course and poor visual outcomes. A comprehensive literature review spanning from 1986 to September, 2024, evaluated the management of C. acnes infections after intraocular surgeries. The primary outcome was improvement in best corrected visual acuity (BCVA). Secondary outcomes included BCVA, retreatments, follow-up duration, and complications stratified by primary surgical intervention. Of the 684 screened articles, 9 retrospective case series were included. Meta-analysis demonstrated significant visual improvement after surgeries (mean difference (MD): 0.62, 95 % CI: 0.15-1.09, p = 0.01). Pars plana vitrectomy (PPV) and PPV combined with IOL removal as first-line approaches yielded superior BCVA outcomes (MD: 0.70, 95 % CI 0.41-1.09, p < 0.00001). PPV-related treatments required fewer retreatments (Odds Ratio (OR): 8.85, 95 % CI: 3.29-23.83, p < 0.0001), but involved longer follow-up duration (MD: -6.53, 95 % CI: -9.57 to -3.49, p < 0.0001). Due to limited data, complications could not be analyzed. The findings suggest that PPV-related treatments significantly improve visual recovery and reduce recurrence rates, albeit with the need for extended follow-up.