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Purpose: To analyse clinical characteristics and risk factors for post-operative endophthalmitis (POE) in a Swedish patient insurance database and compare prevalence of POE with two national quality registers. Methods: We analysed 218 medical records of patients who claimed compensation for POE following ocular surgery from 2010 to 2020. The data were cross-referenced with national quality registers.

Results: In total, 189 of 218 patients presented with severe ocular inflammation with no visibility into the posterior fundus and 160 of 218 had hypopyon. After treatment, the best corrected visual acuity improved from 2.4 to 1.8 LogMAR in mean (p < 0.01). Poorer visual outcome was associated with POE caused by Staphylococcus aureus, Enterococcus faecalis, and Streptococcus infections, as compared to coagulase-negative staphylococci (p < 0.01). Retinal detachment was linked to worse visual prognosis (p = 0.01). Eighteen patients required enucleation or evisceration, three of these had initially undergone vitrectomy, compared with 124 of 200 where the eyes were preserved. Peripheral vitrectomy showed better outcome compared to central vitrectomy (p = 0.02). Financial compensation was granted for 92 % of patients. However, a discrepancy was noted when comparing the number of patients with insurance claims to those reported by the national quality registers, indicating underreporting in both.

Conclusion: This study highlights the impact of bacterial type on visual recovery in POE. Peripheral vitrectomy showed better outcomes than central vitrectomy. Most patients needing enucleation or evisceration were not treated with vitrectomy. Significant discrepancies were found between POE prevalence in quality registers and insurance reports, indicating the need for better reporting, though the exact magnitude of underreporting remains unclear.