Elsevier

Ophthalmology

Volume 114, Issue 12, December 2007, Pages 2133-2137
Ophthalmology

Original article
Incidence of Endophthalmitis after 20- and 25-Gauge Vitrectomy

Presented at: American Academy of Ophthalmology Annual Meeting, November 2006, Las Vegas, Nevada.
https://doi.org/10.1016/j.ophtha.2007.08.009Get rights and content

Purpose

To assess the incidence rate of endophthalmitis after 25-gauge pars plana vitrectomy and to compare it with the endophthalmitis rate after 20-gauge pars plana vitrectomy.

Design

Retrospective, interventional, comparative cohort study.

Participants

Eight thousand six hundred one consecutive pars plana vitrectomy surgery patients.

Methods

Surgeries performed at a single institution between January 1, 2004, and September 1, 2006, were reviewed.

Main Outcome Measures

Incidence of postvitrectomy endophthalmitis.

Results

Endophthalmitis developed in 1 of 5498 eyes after 20-gauge vitrectomy (0.018%) and in 7 of 3103 eyes after 25-gauge vitrectomy cases (0.23%; P = 0.004). Median final visual acuity was counting fingers or hand movements (range, 20/50–no light perception), with comparable results between 20-gauge and 25-gauge endophthalmitis cases.

Conclusions

The visual outcomes of vitrectomy-associated endophthalmitis, for both 20-gauge and 25-gauge vitrectomy, is poor. In this study population, 25-gauge vitrectomy had a statistically significant 12-fold higher incidence of endophthalmitis compared with 20-gauge vitrectomy.

Section snippets

Patients and Methods

Eight-thousand six-hundred one consecutive pars plana vitrectomy cases performed by the Wills Eye Institute Retina Service between January 1, 2004, and August 31, 2006, were reviewed. All surgeries were performed at 1 of 4 surgical locations, which had comparable ancillary support staff and comparable preoperative prepping protocols. All surgeries were performed by 1 of 18 Wills Retina Service physicians.

Preoperative eye preparation in all eyes included eyelid and periorbital scrubbing with

Results

Of the 8601 consecutive cases, 8 (0.09%) had postoperative endophthalmitis. There were 5498 cases of 20-gauge vitrectomy and 3103 cases of 25-gauge vitrectomy. One of 5498 20-gauge vitrectomy cases had endophthalmitis (0.018%), and 7 of 3103 25-gauge vitrectomy cases had endophthalmitis (0.23%; P = 0.004, Fisher exact test, 2 tailed). For the 25-gauge trocar and cannula placement, the vast majority of cases had conjunctival displacement, but no beveling of the surgical wound was performed.

Of

Discussion

Endophthalmitis after intraocular surgery is rare; however, it can result in devastating visual loss. Postoperative endophthalmitis rates vary by surgical procedure. For example, glaucoma procedures tend to have slightly higher rates of endophthalmitis, with a 0.20% rate of endophthalmitis after trabeculectomy.6 Cataract surgery has a low 0.04% incidence of endophthalmitis.6 However, the endophthalmitis rates have not always been this low. As cataract surgery has evolved from intracapsular

Acknowledgment

The authors thank the vitreoretinal surgeons who performed the surgeries involved in this study: Gary Brown, Mitchell Fineman, Allen Ho, Richard Kaiser, J. Arch McNamara, Carl Regillo, James Vander, David Fischer, Sunir Garg, Jay Federman, Carl Park, Arunan Sivalingam, Jonathan Belmont, Robert Kleiner, Mike Samuel, Brian Connolly, and Adam Martidis.

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Manuscript no. 2007-233.

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