Do people with diabetes have a higher risk of developing postoperative endophthalmitis after cataract surgery? A systematic review and meta-analysis

Purpose Postoperative endophthalmitis (POE) is a rare but severe complication of cataract surgery. While diabetes mellitus may increase the risk of POE, the relationship remains unclear. Methods A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Scopus, Medline, Embase, and Google Scholar were searched for relevant studies up to September 10, 2024. The study included both randomized controlled trials and observational studies that evaluated POE outcomes in cataract surgery patients, comparing people with and without diabetes. Random-effects models were used to calculate pooled odds ratios (OR) with 95% confidence intervals (CI). Results Nine studies were included in the systematic review, with seven analyzed in the meta-analysis. The review on POE in people with diabetes undergoing cataract surgery revealed a higher incidence in this group, with a pooled odds ratio (OR) of 1.174 (95% CI: 1.109 to 1.242; p = 0.000) and an incidence rate of 0.261%, compared to 0.242% in people without diabetes. Males with diabetes had a 1.634 times higher risk of POE (p = 0.048), while diabetes and hypertension together increased risk by 3.961 times (p < 0.001). Posterior capsule rupture (PCR) was associated with a significantly higher risk of developing POE, which was also more common in people with diabetes, with an OR of 3.434 (95% CI: 1.789 to 6.591; p = 0.0001). The use of postoperative intracameral and topical antibiotics significantly reduced the risk of POE in both people with and without diabetes (OR: 0.231; p = 0.00). Conclusions This meta-analysis shows that people with diabetes undergoing cataract surgery have a significantly higher risk of POE and PCR compared to those without diabetes, with odds ratios of 1.174 and 3.434, respectively. The administration of intracameral and topical antibiotics significantly reduces the risk of POE in both groups. Our study highlights the importance of maintaining well-controlled blood sugar and blood pressure before surgery. Additionally, extra caution should be taken during surgery to prevent PCR, and appropriate antibiotic use should be considered to minimize the risk of POE.