HBV immunity gaps in older adults undergoing cataract surgery: Opportunistic screening and linkage to care

Abstract

Aim: To assess whether routine preoperative testing in cataract surgery candidates can serve as a practical public health checkpoint for detecting waning hepatitis B immunity and initiating booster-based protection pathways.

Materials and Methods: In this descriptive cross-sectional study, preoperative anti-HBs, HBsAg, anti-HCV, and anti-HIV serologies were evaluated in 430 patients (January 2023 – December 2024) who underwent cataract surgery. Anti-HBs levels were classified as non-protective (<10 mIU/mL), low-protective (10–<100 mIU/mL), or highly protective (≥100 mIU/mL). Chi-square tests and logistic regression were used to analyze immunity levels and associated risk factors.

Results: Among 430 patients (mean age 67.4 ± 9.6 years; 47.4% women), anti-HBs titers were <10 mIU/mL in 47.0% (202/430), 10–<100 mIU/mL in 20.7% (89/430), and ≥100 mIU/mL in 32.3% (139/430). Women had higher odds of non-protective titers (<10 mIU/mL) than men (OR 1.52, 95% CI 1.04–2.23; P=0.031), which persisted after adjustment for age and comorbidity (aOR 1.49, 95% CI 1.04–2.13; P=0.028). HBsAg positivity was 4.4% (19/430); anti-HCV was 2.1% (9/430) and HIV was 0%. Across major comorbidity groups, anti-HBs distributions were broadly similar.

Conclusion: A substantial proportion of patients undergoing cataract surgery lack adequate HBV immunity, emphasizing the need for routine preoperative serological screening and booster vaccination. This pioneering study from Türkiye provides valuable insights into infection control strategies for ophthalmic surgery.