Analysis of pathogenic bacteria and predictors of infectious endophthalmitis after cataract surgery

Postoperative infectious endophthalmitis is a serious complication of cataract surgery. Understanding its risk factors, pathogen distribution, and related biomarkers is crucial for prevention and treatment. This study aimed to investigate the risk factors for postoperative infectious endophthalmitis following cataract surgery, analyze pathogen types, and evaluate the correlation between changes in peripheral blood levels of IL-17, MMP-2, and IGF-1 and the occurrence of this complication.

In this retrospective observational cohort study, 784 patients (1568 eyes) who underwent cataract surgery at Changzhi People's Hospital Eye Hospital from January 2020 to June 2024. Aqueous humor and vitreous fluid were collected from patients with postoperative infectious endophthalmitis for pathogen culture. Basic clinical data of infected and non-infected groups were compared, and differences in serum concentrations of IL-17, MMP-2, and IGF-1 three days after surgery were analyzed to assess the predictive ability of these biomarkers for infectious endophthalmitis.

Among the 784 surgical cases, 46 eyes from 42 patients were diagnosed with infectious endophthalmitis, including 38 cases of unilateral infection (38 patients with one infected eye each) and 4 cases of bilateral infection (4 patients with both eyes infected).Pathogen culture results showed that Gram-positive bacteria were the predominant pathogens (accounting for 73.08%). Univariate and multivariate analyses revealed that diabetes mellitus and vitreous spillage were independent risk factors for postoperative infectious endophthalmitis after cataract surgery. Further analysis of serum biomarkers revealed that serum levels of IL-17 and MMP-2 in the infected group were significantly higher, while IGF-1 was significantly lower than those in the non-infected group three days after surgery (all P < 0.05). Receiver operating characteristic curve analysis indicated that the combined detection of these three biomarkers had a high predictive efficacy for postoperative infectious endophthalmitis after cataract surgery, with an area under the curve of 0.955, a sensitivity of 95.27%, and a specificity of 82.42%.

Although the incidence of postoperative infectious endophthalmitis after cataract surgery is low, the presence of diabetes mellitus and vitreous spillage significantly increases the risk. Gram-positive bacteria are the main pathogens. Changes in serum levels of IL-17, MMP-2, and IGF-1 are closely related to the occurrence of infectious endophthalmitis, and the combined detection of these three biomarkers has high predictive value, providing an important reference for early clinical identification and intervention.