Re: Rodriguez et al.: Association between aphakia and endophthalmitis after pediatric cataract surgery (Ophthalmology. 2023;130:551–553)
Authors: Guangsen Liu, Xiaoyan Yu, Weiwei Xiao
Journal: Ophthalmology (2023)

The recent report by Rodriguez et al1Rodriguez S.H. Chun L.Y. Skondra D. et al.Association between aphakia and endophthalmitis after pediatric cataract surgery.Ophthalmology. 2023; 130: 551-553Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar undeniably stimulates thought on several vital issues, while at the same time putting forth a number of propositions that warrant further scrutiny. The authors draw attention to a markedly higher incidence of endophthalmitis in children compared with adults, citing data from the IRIS® Registry (Intelligent Research in Sight). However, their argument seems to fall short in thoroughly addressing the myriad confounding factors that could potentially contribute to this observed discrepancy. Notably absent is an in-depth exploration of the differences in surgical techniques used for pediatric and adult patients, the varying underlying ocular conditions prevalent in these distinct age groups, and the disparities in systemic health between children and adults.2Raj S.M. Vasavada A.R. Kaid J.S. et al.Post-operative capsular opacification.Nepal J Ophthalmol. 2009; 1: 43-59Crossref PubMed Scopus (15) Google Scholar Each of these factors could significantly influence the incidence of endophthalmitis, and their omission from the discussion raises questions about the completeness of the authors' analysis. The article also identifies a significant correlation between aphakia and endophthalmitis. Although this association is undeniably noteworthy, the authors seem to overlook an important consideration: whether the aphakia was a consequence of a complex cataract surgery or a preexisting condition. This distinction is vital; each scenario could differentially impact the risk of endophthalmitis.3Magone M.T. Kueny L. Singh G.A. et al.Eleven years of cataract surgery in veterans without pre-existing ocular comorbidities.Mil Med. 2019; 184: e191-e195Crossref PubMed Scopus (4) Google Scholar A more thorough exploration of this aspect could have strengthened the authors' argument and provided a more nuanced understanding of the relationship between aphakia and endophthalmitis. Furthermore, the authors do not delve into the critical role of intraoperative and postoperative antibiotic prophylaxis in preventing endophthalmitis. This oversight is particularly significant, given the crucial role of prophylactic measures in cataract surgery, especially in pediatric patients.4Titiyal J.S. Kaur M. Role of intracameral antibiotics in endophthalmitis prophylaxis following-cataract surgery.Indian J Ophthalmol. 2020; 68: 688-691Crossref PubMed Scopus (5) Google Scholar The inclusion of this discussion could have further enriched the paper and provided a more comprehensive picture of endophthalmitis prevention strategies. Lastly, the authors' choice to use the IBM MarketScan Research Database for their study introduces potential limitations. This database may be subject to inherent issues such as coding errors and missing data. Crucial patient-specific information, including the severity of the cataract, specific surgical details, and postoperative care protocols—all factors that could considerably influence the risk of endophthalmitis—are not available in this database. Association between Aphakia and Endophthalmitis after Pediatric Cataract SurgeryOphthalmologyVol. 130Issue 5PreviewEndophthalmitis is a rare but devastating complication of cataract surgery. The IRIS® Registry (Intelligent Research in Sight) reported a significantly higher incidence of endophthalmitis in children compared with adults (0.37% vs. 0.04%). Other studies have reported rates of 0.45% and 0.51%,1-4 but associated factors remain largely unknown. The purpose of this study was to assess factors associated with endophthalmitis after pediatric cataract surgery using a large claims database. Full-Text PDF ReplyOphthalmologyVol. 131Issue 3PreviewWe thank Liu et al for their insightful comments regarding the association between aphakia and endophthalmitis after pediatric cataract surgery. We agree that these issues require further scrutiny, and we are grateful for the opportunity to expand on these important points. Full-Text PDF