Perioperative treatments and endophthalmitis after cataract surgery in France: the national population-based ICCARE study

Cataracts surgeries are the most common ophthalmic procedure worldwide. Despite established guidelines, perioperative topical treatment practices remain heterogeneous. Clarifying real-world prescribing patterns and their association with post-operative endophthalmitis (POE) is essential to optimize postoperative care and patient safety. The aim of this study was to describe perioperative topical treatments, estimate the POE incidence, and identify associated risk factors in France. We conducted a retrospective, population-based cohort study using real-world data from the Système National des Données de Santé (SNDS), the French national health Insurance database. The study included all subjects aged 40 years or older who underwent cataract surgery in France between January 1 and December 31, 2019. The primary outcome was the 42-day postoperative incidence of POE, identified by two ICD-10 diagnostic codes. Secondary outcomes included patterns of perioperative topical drug use and risk factors associated with POE. Associated risk factors were identified using logistic regression. This study included 543,530 patients (815,621 procedures) with a mean age of 73.3 ± 9.0 years, 57.6% of women. Most patients (98.8%) had at least one topical treatment: 97.8% treated with topical antibiotics, 97.0% with steroidal anti-inflammatory eye drops, 90.6% with non-steroidal anti-inflammatory eye drops. The incidence of POE was estimated at 6.4/10,000 patients (n = 347). Male sex and a higher Charlson comorbidity index and cataract surgery in a healthcare facility with < 90% of intraoperative intracameral antibiotics were associated with an increased risk of POE, and topical antibiotics provided no additional benefit. This study conducted in France highlights that cataract surgery is commonly associated with a perioperative treatment involving three different types of eye drops. Although topical antibiotics were commonly administered (97.8%), we found no statistically significant additional benefit beyond intracameral antibiotic prophylaxis in preventing POE.