Comparative Epidemiology and Treatment Patterns of Acute Postoperative and Endogenous Endophthalmitis in South Korea

초록

PurposeTo compare epidemiologic trends, clinical characteristics, and treatment patterns of acute postoperative endophthalmitis (APE) and endogenous endophthalmitis (EE) in a nationwide cohort.MethodsThis retrospective cohort study used Korean National Health Insurance Service claims data from 2013 to 2022. Patients with confirmed endophthalmitis treated by intravitreal injection (IVI) or pars plana vitrectomy (PPV) were included. A total of 7625 patients with APE and 649 with EE were analyzed. APE required recent intraocular surgery; EE required systemic infection and exclusion of corneal ulcer - associated endophthalmitis. Outcomes included yearly trends, patient profiles, treatment type (IVI, PPV, or combined), and outpatient care within one year.ResultsAmong 16,009 patients with endophthalmitis, 7625 (47.6%) had APE and 649 (4.1%) had EE. APE cases increased until 2020-peaking during a fungal outbreak from contaminated viscoelastic material - then declined. The proportion of IVI-related APE rose from 13.1% in 2013 to 26.2% in 2022. EE cases remained stable. EE patients were younger (mean age, 62.6 vs. 67.6 years) and had greater comorbidity (mean Charlson Comorbidity Index, 1.30 vs. 0.98). IVI-only was most common in both groups, whereas combined IVI with PPV was more frequent in EE. Outpatient care was less common in EE (57.6% vs. 83.4%) yet lasted longer (median 269 vs. 67 days) with more IVIs (mean 3.48 vs. 2.62 injections).ConclusionAPE was more prevalent and increasingly IVI-associated. EE, though less common, involved greater systemic morbidity and longer treatment duration. Findings underscore the need for infection control in IVI and multidisciplinary EE care.

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