Abstract
Purpose :
To compare 1-year post-operative outcomes after cataract surgery in patients with and without a 1-year history of Vancomycin use.
Methods :
A retrospective cohort study was done using TriNetX (Cambridge, MA, USA), a federal electronic medical database including 69 million records from multiple large health organizations in the United States. Patients who underwent cataract surgery were identified by CPT code and stratified into two cohorts: those with and without a 1-year history of vancomycin use. Cohorts were controlled for age, gender, and medical comorbidities (essential hypertension, diabetes mellitus, chronic lower respiratory diseases, heart failure, nicotine dependence, and body mass index) using a 1:1 matched propensity score analysis. The 1-year outcomes measured were: vitreous hemorrhage (VH), choroidal hemorrhage (CH), retinal detachment (RD) or break, iridocyclitis, retinal edema (RE), corneal edema (CE), cystoid macular edema (CME), epiretinal membrane (ERM), toxic maculopathy (TM), ischemic optic neuropathy (ION), glaucoma, strabismus, dry eye, central retinal vein occlusion (CRVO), central retinal artery occlusion (CRAO), vitreous opacities, ptosis, endophthalmitis, and retinal vascular occlusions (RVO).
Results :
A total of 32,716 cataract surgery patients were included in analysis with 16,358 in each cohort with and without a 1-year history of vancomycin use. The cohort with history of vancomycin use had a significant greater risk of RE (RR, 1.24; 95% CI, 1.04-1.49), CME (RR, 1.23; 95% CI, 1.08-1.4), ERM (RR, 1.28; 95% CI, 1.1-1.48), ION (RR, 2.17; 95% CI, 1.1-4.3), glaucoma (RR, 1.23; 95% CI, 1.09-1.3), dry eye (RR, 1.26; 95% CI, 1.14-1.39), ptosis (RR, 1.27; 95% CI, 1.06-1.53), and endophthalmitis (RR, 2.02; 95% CI, 1.47-2.76), whereas the cohort with no history of vancomycin use had a significant greater risk of vitreous opacities (RR 0.77; 95% CI, 0.64-0.93). No significant difference was seen in the rate of development of VH, CH, CE, RD or break, iridocyclitis, TM, strabismus, CRVO, CRAO, or RVO between the two cohorts.
Conclusions :
Medication history, specifically vancomycin antibiotic use, is an important factor to consider when evaluating postoperative complications of cataract surgery. A 1-year history of vancomycin use increased the risk of developing potentially sight-threatening ocular disorders such as endophthalmitis, glaucoma, and ION, but decreased the risk of vitreous opacities.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.