Article

Incidence of Endophthalmitis after 20- and 25-Gauge Vitrectomy

January 2008
Ophthalmology 114(12):2133-7

January 2008
114(12):2133-7

DOI:10.1016/j.ophtha.2007.08.009

Source
PubMed

Authors:

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. Retrospective, interventional, comparative cohort study. Eight thousand six hundred one consecutive pars plana vitrectomy surgery patients. Surgeries performed at a single institution between January 1, 2004, and September 1, 2006, were reviewed. Incidence of postvitrectomy endophthalmitis. 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. 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.

Endophthalmitis after pars plana vitrectomy with reused single-use devices: a 13-year retrospective study

Article

Full-text available

Dec 2021

Background To describe the incidence, clinical characteristics, and treatment outcomes of endophthalmitis after pars plana vitrectomy (PPV) with recycled single-use devices. The recommended sterilization process as well as safety measures are discussed. Methods Medical charts of patients who developed endophthalmitis after PPV were retrospectively reviewed and reported in a descriptive manner. Cases undergoing PPV for preexisting endophthalmitis or open globe injury were excluded. Data collection included patient demographics, operative details, ocular findings, microbiological profiles, treatment modalities, and visual outcomes. Results Over the past thirteen years, a total of 12,989 pars plana vitrectomy operations were included. In total, 13 eyes of 13 cases (0.10%) experienced endophthalmitis after vitrectomy. These occurred in 3 cases (0.11%) using 20-gauge vitrectomy compared to 8 cases (0.09%) using 23-gauge vitrectomy and 2 cases (0.18%) using 25-gauge vitrectomy. There were no statistically significant differences between the 20-gauge and microincisional vitrectomy surgery (MIVS) group (P = 0.64), and the 23- and 25-gauge approach (P = 0.34). Causative pathogens were positive by culture in 5 cases (45%): 3 g-positive cases, 1 g-negative case, and 1 fungus case. Conclusions The rate of endophthalmitis in patients who underwent 23-gauge PPV was comparable to those who underwent 25-gauge PPV. With our standardized protocol for instrument sterilization, endophthalmitis rates in those undergoing PPV using recycled single-use instruments were within the range of previously published results in which vitrectomy tools were disposed of after one use.

ENDOPHTHALMITIS AFTER TRANSCONJUNCTIVAL PARS PLANA VITRECTOMY: A 6-year Experience Without Prophylactic Intraoperative Subconjunctival Antibiotics

Article

Full-text available

Aug 2020
RETINA-J RET VIT DIS

Purpose: This study aimed to investigate the incidence and risk factors of endophthalmitis after transconjunctival pars plana vitrectomy (PPV) without intraoperative subconjunctival antibiotics. Design: Retrospective, consecutive case series at a single institution. Methods: Consecutive cases of transconjunctival 25-gauge PPV without intraoperative subconjunctival antibiotics performed by three retina surgeons at a single surgical site at the Dean McGee Eye Institute from 2012 to 2018 were reviewed. Results: Of 4,263 cases of PPV without intraoperative subconjunctival antibiotics, five cases (0.117%, 5/4,263) of post-PPV endophthalmitis were identified. Of these five cases, four cases (80%, 4/5) received combined cataract extraction or secondary intraocular lens implantation at the time of PPV. The incidence of endophthalmitis in isolated PPV was 0.027% (1/3,606 cases), whereas the incidence in combined PPV with anterior segment procedures was 0.608% (4/657 cases). Risk factors for endophthalmitis included diabetes mellitus, which was present in 80% of patients with endophthalmitis (4/5 cases). Causative organisms were identified in four of the five cases (80%), including Staphylococcus epidermidis (N = 3) and Propionibacterium acnes (N = 1). Conclusion: Performing transconjunctival PPV alone with standard preparation using povidone-iodine and postoperative topical antibiotics for 1 week without intraoperative subconjunctival antibiotics did not lead to an increase in incidence of postoperative endophthalmitis (1 per 3,606 cases).

Incidence of endophthalmitis after 23-gauge pars plana vitrectomy

Article

Full-text available

Jan 2018
BMC Ophthalmol

Background Endophthalmitis is a rare but severe complication following PPV. The incidence of endophthalmitis varies between 20-gauge, 23-gauge, and 25-gauge incisions. The incidence and clinical features of endophthalmitis after 23-gauge PPV in an eye hospital in China was reported in this study. Methods Data of the eyes that underwent 23-gauge PPV from January 2011 to December 2014 at the Eye Hospital of Wenzhou Medical University was retrospectively collected. All the information was obtained from the electronic medical system. The exclusion criteria included: (1) preoperative diagnosis of endophthalmitis; (2) history of vitrectomy; (3) intraocular surgery within 6 months; (4) history of ocular penetrating trauma; (5) sutures for any of the 3 sclerotomy incisions; (6) patients with cancer, acquired immune deficiency syndrome, or taking drugs that may influence the immune system. The diagnosis of endophthalmitis was based on clinical characteristics and/or culture results from an operative sample. ResultsThree thousand nine hundred seventy nine eyes that underwent 23-gauge PPV surgery were included in this study. Among these eyes, 3 eyes developed endophthalmitis after surgery, giving an incidence of 0.075% (3/3979). The period in which endophthalmitis developed ranged from 1 to 5 days post-operation. The visual acuity decreased to hand motions or light perception postoperatively. The culture of aqueous and vitreous of the 2 eyes revealed Staphylococcus epidermidis and enterococcus faecalis respectively, however was negative for the third eye. All 3 eyes had a favorable response to the treatment of vitreous tap and intravitreal antibiotics injection. Two eyes gained visual acuity of 0.05 and 0.5, respectively at the final visit. Conclusions Endophthalmitis is a rare but sight-threatening complication after 23-gauge pars plana vitrectomy. The peak duration of onset was within 5 days post-operation, with gram positive cocci being the common pathogenic organism.

Incidence, microbiology, and outcomes of endophthalmitis after 111,876 pars plana vitrectomies at a single, tertiary eye care hospital

Article

Full-text available

Jan 2018
PLOS ONE

Purpose To describe the incidence, risk factors, clinical presentation, causative organisms, and outcomes in patients with endophthalmitis following pars plana vitrectomy (20G and minimally invasive vitrectomy surgery (MIVS). Methods Of 111,876 vitrectomies (70,585 20-G 41,291 MIVS) performed, 45 cases developed acute-onset, postoperative endophthalmitis. Results The rate of culture positive and culture negative endophthalmitis was 0.021% (2.1/10,000 surgeries) and 0.019% (1.9/10,000 surgeries) overall, 0.031% (3.1/10,000 surgeries) and 0.025% (2.5/10,000 surgeries) in 20G, and 0.005% (0.5/10,000 surgeries) and 0.007% (0.7/10,000 surgeries) in the MIVS group respectively. Potential predisposing factors were as follows: diabetes, 46.7%; vitrectomy for vascular retinopathies, 44.4%; and vitrectomy combined with anterior segment surgeries, 35.5%. The culture proven rates were 53.3% overall, 55.0% for 20G and 40.0% for MIVS. The most common organism was Pseudomonas aeruginosa for 20G. Klebsiella and Staphylococcus aureus were isolated in the two culture positive cases in MIVS group. The follow-up period for the patients with endophthalmitis was 586.14 ± 825.15 days. Seven were lost to follow up beyond one week. Of the remaining 38, 13 (34.2%) cases had a favorable visual outcome (i.e., best-corrected visual acuity [BCVA] > 5/200) and 24 (63.2%) had unfavorable visual outcome (BCVA < 5/200). Group with culture test results negative had significantly better outcomes (P < 0.05) as compared to those with positive. Conclusions MIVS does not increase the risk of endophthalmitis. Outcomes are poor despite appropriate treatment, particularly in cases with culture results positive.

Incidence of post vitrectomy endophthalmitis in India – A multicentric study by VRSI study Group

Article

Full-text available

Feb 2023

Introduction: The incidence of post vitrectomy endophthalmitis (PVE) is reported to be between 0.02 and 0.84%. Resterilization of single use instruments is a common practice amidst developing countries to make it more affordable to the patients by reducing the cost of the surgery and also reduce the environmental hazard. The aim of our study is to evaluate the incidence of PVE amidst existing sterilization practices of reused instruments in multiple vitreoretinal centres in India. Methodology: Centres with an endophthalmitis tracking system were invited to participate in a survey. Twenty-five centres were sent a questionnaire via email. The questionnaire included details about the institution, number of vitrectomies performed in a year, sterilization practices followed pre-operatively, intraoperatively and postoperatively, incidence of endophthalmitis and instrument reuse policies. Results: A total of 29 cases of endophthalmitis were reported out of the 47,612 vitrectomies performed across various centres. The mean incidence of endophthalmitis was 0.06%. There was no difference in the rates of endophthalmitis based on various pre-operative, intraoperative or postoperative prophylactic measures. Nearly 80% of the centres change most of the instruments after every case, while the rest reused. The mean number of times a cutter was being reused until discarded was 4.7. Nearly 76% followed a performance-based protocol, and the remaining 24% had a fixed protocol for the number of times an instrument can be reused before discarding it. Conclusion: PVE rates are not significantly different in India despite the multiuse of single use instruments. The purpose of this paper is not to suggest an alternate protocol but to creating one in the future with these results in mind, to rationalise the use of single use instruments, make VR surgery more affordable and also have a positive impact on the carbon footprint of consumables in surgery.

Intravitreal dexamethasone: variation of surgical technique and prevention of ocular complications with ASOCT follow-up

Article

Full-text available

Apr 2022
GRAEF ARCH CLIN EXP

Purpose To verify the correct decision-making procedure on performing an intravitreal injection by investigating the in vivo wound morphology and evolution of 22-gauge wounds after dexamethasone oblique injection with anterior segment optical coherence tomography (OCT). Design Prospective, observational consecutive case series. Methods Subjects underwent a dexamethasone injection at University Eye Clinic of Turin. All the injections have been performed in an oblique (aka beveled or angled) fashion. Patients were divided according to the number of injections already performed with dexamethasone. Group 1 consisted of patients at the first injection, group 2 of patients at a second or more injection always in the same quadrant, and group 3 of patients at the second or more injection in a different quadrant. The incisions were imaged with the Heidelberg SPECTRALIS OCT device on postoperative days 1, 8, and 15. The main outcome measure was wound structure/characteristics (e.g., presence of gaping) as evaluated with OCT. Surgical and ocular parameters were also recorded. Results Thirty-three consecutive patients were investigated. OCT demonstrated closed wounds in all eyes on postoperative days 1, 8, and 15. In all patients, the external (entry) side of the incision was seen as a gape; however, the rest of the wound was closed. No complications were recorded in the different patients during the follow-up. In patients of group 1, we identified the scleral pathway in 10 eyes at day 1. At 8 days in 9 of 10 eyes, the sclera had returned to its restitutio ad integrum . In patients of group 2, the scleral pathway was recognizable on the first day of control; in 7 patients, this was accompanied by the presence of intrascleral edema with peri-wound fluid. At the 8-day checkup, 3 eyes still showed signs attributable to the intrascleral pathway accompanied by peri-wound edema. In group 3, it was possible to identify the intrascleral pathway in 8 patients. There were no signs of intrascleral peri-wound edema or other anatomical changes in 9 patients as early as the first day. In the 8-day follow-up, the signs of scleral edema were absent in the single patient who presented them. At 15 days, there were no signs of scleral pathway in all eyes analyzed. Conclusions Speaking of intravitreal injections of slow-release dexamethasone, the technique that involves moving the conjunctiva and a beveled or angled sclerotomy after a careful choice of the injection site, paying attention to vary the quadrant involved with each puncture, reduces the number of days of closure of the sclera via and the scleral damage, thus protecting the patient from complications. For the future, it is hoped that the operating microscope and intraoperative OCT will be used on every occasion.

The Clinical and Safety Outcomes of 27 Gauge Pars Plana Vitrectomy in Eyes With Macular Hole

Article

Full-text available

Apr 2022

Objective To report the clinical, visual, and safety outcomes of 27 gauge pars plana vitrectomy (27G PPV) in eyes with full thickness and lamellar macular hole (MH). Methodology This retrospective cross-sectional study, conducted at the ophthalmology department of Shifa International Hospital, Islamabad, was done on 89 eyes of 85 patients who underwent 27G PPV for full-thickness and lamellar MH with a postoperative follow-up period of six months. Results The mean age was 61.9 ± 17.3 years with 57.3% being males. Most of the eyes had idiopathic stage III full- thickness MH (n=34, 38.2 %). The total mean operating time was 42.5 ± 19.8 minutes. During surgery, 48 (53.9%) eyes had concurrent phacoemulsification. Hexafluoroethane was the most commonly used tamponade agent (n=81, 91%). Postoperatively, the primary closure rate was 93.2% (n=83) while the final closure rate was 100% (n=6) either by prolonged posturing (n=3, 3.3%) or by an additional procedure involving autologous internal limiting membrane (ILM) transplant (n=3, 3.3%). The complication rate was 2.2% including iatrogenic retinal tear (n=1, 1.1%) and raised IOP (n=1, 1.1%). The overall best-corrected visual acuity (BCVA) improved significantly from 1.20 ± 0.67 to 0.31 ±0.17 (p=<0.001). Conclusion As per this study, 27G PPV is a practical and efficient surgical system with substantial anatomical success, minimal complication, and considerable visual recovery rates in eyes with full thickness and lamellar MH. We suggest 27G PPV with ILM peeling and medium-acting intraocular gas as the standard procedure for MH.

Is it necessary to use tobramycin-dexamethasone eye ointment prophylactically in eyes at the end of intraocular surgery?

Article

Full-text available

May 2020
BMC Ophthalmol

Background: There are no data available regarding the complications associated with using antibiotic ointment at the end of intraocular surgery. This study aimed to explore the necessity of using ocular tobramycin-dexamethasone prophylactically at the end of intraocular surgery. Methods: This was a retrospective cohort study of patients who received intraocular surgery at Tianjin Medical University General Hospital from January 2015 to December 2017. The patients were grouped according to whether they received tobramycin-dexamethasone eye ointment or not after surgery. The Tobramycin dexamethasone eye ointment was sampled to observe bacterial contamination pathogens at 0.5, 1, 1.5, 2, 2.5, 3, 6, 8, 24, 36, 48, 72, and 168 h after being opened. Results: A total of 3811 eyes in 3811 patients (mean age of 63 ± 12 years) were included: 2397 eyes that received prophylactic tobramycin-dexamethasone eye ointment and 1414 eyes that did not. The overall rate of endophthalmitis was 0.08% (3/3811) in our study, all in the eye ointment group (0.12%, 3/2397); no patients developed endophthalmitis in the non-ointment group (0%, 0/1414)(P = 0.184). The anterior chamber reactions 1 day after surgery were more serious in the eye ointment group compared with the non-ointment group (all P < 0.05), but there were no statistically significant differences at 1 month postoperatively (all P > 0.05). The contamination rate was 0% at all time points over 7 days. Conclusion: We did not observe a statistically significant difference in the incidence of endophthalmitis in patients with or without prophylactic tobramycin-dexamethasone eye ointment. And tobramycin-dexamethasone eye ointment seemed to increase some side effects such as eye secretions increasing and foreign body feeling.

Comparative study of microbiological profile and management outcomes of acute endophthalmitis after microincision vitrectomy surgery (MIVS) versus intravitreal injections (IVI)

Article

Jan 2020

Purpose: To evaluate and compare incidence and outcomes of management of acute endophthalmitis after microincision vitrectomy surgery (MIVS) and intravitreal injections (IVI). Methods: Medical records were retrospectively reviewed from January 2012 to December 2017, and the incidence, clinical and microbiological profile of acute endophthalmitis were documented. Results: Out of a total of 26332 MIVS and 24143 IVI performed, incidence of acute endophthalmitis in MIVS group was 0.027% (1 in 3761 cases) against 0.054% (1 in 1857 cases) in IVI. Gram positive organisms were causative in post IVI group as against gram negative organisms in MIVS group. Conclusion: Incidence of endophthalmitis after IVI is almost twice that after MIVS. A trend towards poorer outcomes in MIVS eyes was observed. Both MIVS and IVI being pars plana procedures warrant similar kind of aseptic precautions.

Preoperative preparation of eye with chlorhexidine solution significantly reduces bacterial load prior to 23-gauge vitrectomy in Swedish health care

Article

Full-text available

Jul 2018
BMC Ophthalmol

Background: Bacteria in the conjunctiva present a potential risk of vitreous cavity infection during 23-gauge pars plana vitrectomy (PPV). Current preoperative procedures used in Sweden include irrigation with chlorhexidine solution (CHX) 0.05% only and no iodine solutions. We evaluated the bacterial diversity and load before and after this single antibacterial measure. Methods: In a prospective, consecutive cohort we investigated bacterial growth in samples from 40 eyes in 39 consecutive individuals subjected to vitrectomy. A conjunctival specimen was collected from each preoperative patient before and after irrigating of eye with CHX, 0.05% solution. Iodine was not used during any part of the surgery. One drop of chloramphenicol was administered prior to surgery. Samples from vitreous cavity were collected at the beginning and end of vitrectomy. All conjunctival specimens were cultured for different species and quantified using colony forming units (CFU). Results: There was a significant 82% reduction in the total number of CFUs for all bacteria in all eyes (P < 0.0001), and 90% reduction for coagulase negative staphylococci (CoNS) alone (P = 0.0002). The number of eyes with positive bacterial growth in conjunctival samples decreased from 33 to 18 after irrigation with CHX (P = 0.0023). The most common bacteria prior to surgery were CoNS (70%), Propionibacterium acnes (55%) and Corynebacterium species (36%). No case of post-vitrectomy endophthalmitis was reported during mean follow-up time, which was 4.6 ± 2.3 (range; 1.5 to 9) months. Conclusions: Patients undergoing PPV harbored bacteria in conjunctiva capable of causing post-vitrectomy endophthalmitis. Preoperative preparation with CHX significantly reduced the bacterial load in the conjunctival samples subsequently leading to very low inoculation rates in recovered vitreous samples. Thus, CHX used as a single disinfectant agent might be an effective preoperative procedure for eye surgery in Sweden. This is a relatively small study but the results could be a reference for other intraocular surgeries.

The rate of endophthalmitis after pars plana vitrectomy and its risk factors

Article

Full-text available

Jun 2019
Int Ophthalmol

PurposeTo study the incidence of endophthalmitis after pars plana vitrectomy, its causative organisms, and visual acuity outcomes. Patients and methodsIn this retrospective, comparative study, the medical records of patients with acute-onset postoperative endophthalmitis after pars plana vitrectomy at Farabi Eye Hospital, Tehran, Iran, during a 12-year period between January 2004 and November 2015 were reviewed. To compare the endophthalmitis patients with other cases who underwent pars plana vitrectomy at the same day and also the same operating room, a control group was developed by gathering the data from surgical records. ResultsIn the present study, the incidence rate of pos- vitrectomy endophthalmitis was 0.04% (16/39783). The organisms identified in aqueous or vitreous cultures (culture positive 44%) included Streptococcus pneumoniae (two patients, 12.5%), Pseudomonas aeruginosa (two patients, 12.5%), fungi (two patients, 12.5%), and Streptococcus viridans (one patient, 6.25%). Visual acuity after treatment for endophthalmitis ranged from light perception (7 eyes) to hand motion (1 eye), and evisceration was performed in 8 eyes (50%). When comparing the cases (patients developing endophthalmitis) and controls (patients with no complications operated in the same day and place of operation with the case group), only not using tamponade showed a statistically significant relation with the occurrence of endophthalmitis (p = 0.034). Conclusion Our results indicated low incidence of endophthalmitis after pars plana vitrectomy comparable to previous studies which resulted in poor visual acuity. It seems that not using tamponade might increase the risk of endophthalmitis among these patients.

Preoperative estimation of retinal hole location using ultra-wide-field imaging

Article

Full-text available

Sep 2023

Background/Objective Accurate localization of retinal holes is essential for successful scleral buckling (SB) surgery. We aimed to verify the feasibility of using ultra-wide-field (UWF) imaging for preoperative estimation of retinal hole location. Patients and Methods We observed 21 eyes from 21 patients with rhegmatogenous retinal detachment (RRD) who underwent successful SB. They were treated at the Department of Ophthalmology of the Second Hospital of Hebei Medical University between November 2020 and November 2021. UWF fundus photography using an Optos device was performed at different steering positions 1 day before, 1 day after, and 1 month after SB. Using the preoperative fundus images, we measured the transverse diameter of the optic disc (D1) and the distance from the centre of the retinal holes to the ora serrata (D2). The accurate transverse diameter of the optic disc (Dd) was measured preoperatively using optical coherence tomography. The same surgeon measured the scleral chord lengths intraoperatively from the limbus to the located retinal hole marked on the sclera using an ophthalmic calliper. Statistical software was used to analyze the consistency of scleral chord length between the retinal hole and the limbus, which was estimated by preoperative UWF imaging and was measured using an ophthalmic calliper intraoperatively. Results There was no statistically significant difference in the scleral chord length between the retinal holes and the limbus, which was estimated by preoperative UWF fundus photography and was measured by the calliper during surgery. Conclusion It is feasible to locate retinal holes using UWF fundus photography before SB, which is helpful for quick localization, thereby reducing the learning curve of SB surgery.

Conjunctival Pigmentation Following Pars Plana Vitrectomy (PPV) for Rhegmatogenous Retinal Detachment: Risk Factors and Outcomes

Article

Full-text available

Mar 2023

Purpose: To investigate the incidence and the risk factors for conjunctival pigmentation at the sclerotomy sites following valved and non-valved cannula pars plana vitrectomy (PPV) performed by different surgical techniques. Methods: This is a prospective observational study which included 70 eyes of 70 patients who underwent PPV for rhegmatogenous retinal detachment with follow-up visits at 1, 3, 6, 12, and 24 months. Twenty-eight eyes were operated using 25G non-valved cannulas (Group A), 22 eyes using 25G non-valved cannulas (Group B), and 20 eyes using 25G valved cannulas (Group C). The evaluated clinical parameters include the surgical technique, the patients' age, the number of retinal tears, the tamponade agent, the presence of residual sub-retinal fluid (SRF), and the duration of postoperative posturing. Results: Group A was associated with significant conjunctival pigmentation at up to 6 months after PPV. Sulfur hexafluoride (SF6) gas tamponade was associated with less conjunctival pigmentation at 3 months follow-up visit [odds ratio, OR 0.09 (95% confidence interval, CI 0.01; 0.67)], whereas the presence of residual SRF was a significant risk factor for postoperative pigmentation at 1-year follow-up visit [OR 5.89 (95% CI 1.84; 23.12)]. The area of measured pigmentation was also positively correlated to the number of retinal tears at all follow-up visits over 2 years. Six patients presented with conjunctival pigmentation at 2 years follow-up visit. Conclusion: New vitrectomy techniques with valved cannulas prevent the postoperative appearance of conjunctival pigmentation. The number of retinal tears, the presence of SRF, and the use of long-standing tamponade agents were the most significant predisposing factors. The post-vitrectomy conjunctival pigmentation gradually reduces over time.

Monopolar coagulator for surgery with suprachoroidal access

Article

Sep 2021

Retinal detachment is a pathological condition that leads to vision loss without timely surgical treatment. To restore the anatomical integrity of the detached retina, a number of surgical interventions (Scleral Buckling, Pars Plana Vitrectomy, a combined Pars Plana Vitrectomy/Scleral Buckling, Pneumatic Retinopexy, cryo-, laser-, and electropexy) and approaches to the damaged area are traditionally used, among which one of the new and promising are monopolar high-frequency electrocoagulation with suprachoroidal access. The advantages of this method and access are the possibility of manipulations on hard-to-reach structures of the eye (choroid, outer parts of the retina and macula), to introduce medical drugs into the suprachoroidal space without side effects. To carry out such an operation, we developed (manufactured and tested) a new surgical electrical instrument capable of restoring the anatomical integrity of a detached retina. The tool is a working electrode, which consists of a handle, a terminal (for connecting the electric cord to the active phase of the high-frequency electric current generator) and a working tip. The rounded tip is made of gold and ends in a sphere with a diameter of 25 G. The radius of the round is 29.0 mm, the diameter of the cross section is 0.5 mm. The tool allows you to reach the damaged area of the retina through both suprachoroidal and endovitreal accesses. The rounded shape of the working part of the tool repeats the anatomical curvature of the fundus of the eye. The materials chosen for the manufacture of the new tool take into account the need for its sterilization, electrical safety and ergonomics of work. Keywords: retinal detachment, high-frequency electrocoagulation, electric instrument for vitreoretinal surgery.

Vitreous hemorrhage -Causes, diagnosis, and management

Article

Full-text available

Dec 2022
Indian J Ophthalmol

Quick Response Code: Vitreous hemorrhage is associated with a myriad of conditions such as proliferative diabetic retinopathy, proliferative retinopathy following vascular occlusion and vasculitis, trauma, retinal breaks, and posterior vitreous detachment without retinal break. Multiple pathological mechanisms are associated with development of vitreous hemorrhage such as disruption of abnormal vessels, normal vessels, and extension of blood from an adjacent source. The diagnosis of vitreous hemorrhage requires a thorough history taking and clinical examination including investigations such as ultra-sonography, which help decide the appropriate time for intervention. The prognosis of vitreous hemorrhage depends on the underlying cause. Treatment options include observation, laser photo-coagulation, cryotherapy, intravitreal injections of anti-vascular endothelial growth factor, and surgery. Pars plana vitrectomy remains the cornerstone of management. Complications of vitreous hemorrhage include glaucoma (ghost cell glaucoma, hemosiderotic glaucoma), proliferative vitreoretinopathy, and hemosiderosis bulbi.

Incidence rate and clinical characteristics of acute endophthalmitis following 23-gauge pars plana vitrectomy

Article

Full-text available

Dec 2022

Purpose In this study, we evaluated the incidence and clinical characteristics of post-vitrectomy acute endophthalmitis in a tertiary eye center. Methods Data were obtained by reviewing the patients’ medical records who underwent primary pars plana vitrectomy (PPvitx) from September 2011 to March 2017. We excluded patients who had any ocular surgery in the past 6 months, immunocompromised patients, and patients with a pre-operative diagnosis of endophthalmitis. The primary outcome was the incidence of acute post-pars plana vitrectomy endophthalmitis. Results Out of 6474 cases who underwent PPvitx, 12 cases of endophthalmitis (incidence rate of 0.18%) were identified. We found two positive cultures for staphylococcus epidermidis and one positive culture for staphylococcus aureus. Underlying causes of primary vitrectomy in patients who got endophthalmitis were diabetic retinopathy (8 cases), rhegmatogenous retinal detachment (2 cases), and the epiretinal membrane (1 case), and non-clearing vitreous hemorrhage secondary to central retinal vein occlusion (1 case). Conclusion In the present study, the rate of post-vitrectomy acute endophthalmitis was higher than in other reported studies.

Incidence rate and clinical characteristics of acute endophthalmitis following 23- gauge pars plana vitrectomy using recycled single-use equipment

Preprint

Full-text available

Jul 2022

Purpose: In this study, we evaluated the incidence and clinical characteristics of post- vitrectomy acute endophthalmitis, while as a developing country for economic reasons we have to use recycled single-use vitrectomy tools. Methods: Data were obtained by reviewing the patient’s medical records who underwent primary pars plana vitrectomy (PPvitx) from September 2011 to March 2017 retrospectively. We excluded patients who had any ocular surgery in the past 6 months, immunocompromised patients, and patients with a pre-operative diagnosis of endophthalmitis. The main outcome was defined as the incidence of acute post-pars plana vitrectomy endophthalmitis. Results: Out of 6474 cases who underwent PPvitx, 12 cases of endophthalmitis (incidence rate of 0.18%) were identified. We found two positive cultures for staphylococcus epidermidis and one positive culture for staphylococcus aureus. Based on the medical records of the patients, nine patients (75%) had diabetes and 1 (8.3%) had hypertension. Conclusion: Reuse of surgical instruments (despite standard sterilization protocols) could be a risk factor for higher rates of endophthalmitis after PPvitx in this study.

Preoperative preparation of the eye with TiAB wipes significantly reduces bacterial load: a case series

Article

Full-text available

May 2020

Influence of Perfluorocarbon Liquids on Peripapillary Retinal Nerve Fiber-Layer Thickness Following Pars Plana Vitrectomy with Silicone Oil- Based Endotamponade

Article

Oct 2020

Efficacy and Safety Profile of 25-Gauge Pars Plana Vitrectomy in Rhegmatogenous Retinal Detachment in Pakistan: A Multicenter Retrospective Study

Article

Full-text available

Mar 2022

Introduction This study aims to evaluate the primary anatomical success and visual outcomes of 25-gauge pars plana vitrectomy (25g PPV) in patients with rhegmatogenous retinal detachment (RRD) in Pakistan. Design This is a five-year retrospective, interventional cohort study conducted at tertiary care hospitals in Pakistan from October 2013 to October 2018. Methods This is a retrospective, interventional cohort study of 418 consecutive patients with RRD who underwent 25g PPV. All surgeries were performed by two experienced surgeons at tertiary care hospitals in Pakistan. Consecutive patients who underwent 25g PPV surgery as the treatment for RRD from October 2013 to October 2018 were included. We excluded patients who had a history of previous retinal surgery or did not complete the 4-8 weeks of primary outcome visit. We used the Statistical Package for the Social Sciences (SPSS) version 23.0 (IBM Corporation, Armonk, NY, USA) for statistical analysis. A p-value of <0.05 was considered significant. Results We identified 452 patients through the coding system of our hospitals who underwent 25g PPV surgery for RRD during the study period. A total of 441 patient files were reviewed for the study, of which 418 patients met the criteria for final analysis. The mean age was 49 ± 15.8 years. There was a higher number of males (n = 284, 67.9%). In our study, 186 (44.4%) patients were phakic at the time of presentation. The macula was detached in 361 (86.4%) patients. At the primary outcome visit (4-8 weeks of follow-up), the primary anatomical success rate was 89.47%. The most common cause of failure was proliferative vitreoretinopathy (PVR) (n = 20), followed by missed breaks (n = 5). Conclusions The surgical outcomes of RRD with 25g PPV surgery in our study were similar to the outcomes reported in the developed world. We propose a prospective multicenter national study to prospectively evaluate the risk factors for RRD surgical failure in the Pakistani population.

Laser-induced nanobubbles safely ablate vitreous opacities in vivo

Article

Full-text available

May 2022
Nat. Nanotech.

In myopia, diabetes and ageing, fibrous vitreous liquefaction and degeneration is associated with the formation of opacities inside the vitreous body that cast shadows on the retina, appearing as ‘floaters’ to the patient. Vitreous opacities degrade contrast sensitivity function and can cause notable impairment in vision-related quality of life. Here we introduce ‘nanobubble ablation’ for safe destruction of vitreous opacities. Following intravitreal injection, hyaluronic acid-coated gold nanoparticles and indocyanine green, which is widely used as a dye in vitreoretinal surgery, spontaneously accumulate on collagenous vitreous opacities in the eyes of rabbits. Applying nanosecond laser pulses generates vapour nanobubbles that mechanically destroy the opacities in rabbit eyes and in patient specimens. Nanobubble ablation might offer a safe and efficient treatment to millions of patients suffering from debilitating vitreous opacities and paves the way for a highly safe use of pulsed lasers in the posterior segment of the eye.

Intravitreal injections as a leading cause of acute postoperative endophthalmitis—a regional survey in England

Article

Full-text available

Dec 2021

Background To evaluate the characteristics, treatment patterns and outcomes of acute postoperative endophthalmitis. Methods Patients presenting with acute postoperative endophthalmitis between January 2017 to December 2019 were identified from hospital records in this multicentre retrospective cohort study. Clinical records were reviewed for visual acuity (VA) at various timepoints, cause of endophthalmitis, microbiological results, treatments and complications. Results Forty-six eyes of 46 patients were included. Intravitreal injections were the leading cause of acute postoperative endophthalmitis ( n = 29; 63%), followed by cataract surgery ( n = 8; 17%), vitreoretinal surgery ( n = 7; 15%), and secondary intraocular lens insertion ( n = 2, 4%). The absolute risk of endophthalmitis was 0.024% (1:4132) for intravitreal injections, 0.016% (1:6096) for cataract surgery, and 0.072% (1:1385) for vitreoretinal surgery. The majority of patients ( n = 38; 83%) had better VA at 6 months compared to presentation, although fewer ( n = 13; 28%) maintained similar or better VA compared to before the precipitating surgery. Twenty-four cases yielded positive culture results, of which staphylococcus epidermidis was the most commonly isolated organism. Microbiological yield was not associated with better final visual outcomes. Patients who underwent therapeutic vitrectomy ( n = 15; 33%) had poorer VA at presentation, but subsequently achieved visual outcomes comparable to those who received medical treatment alone. There was no difference in time to presentation, visual outcome and retinal detachment rates among the different causative procedures. Conclusion Intravitreal injections were the most common cause of endophthalmitis in our region, primarily because of their higher frequency compared to other intraocular procedures. In this cohort, the primary procedure had no effect on presentation, management or visual outcomes.

Outcomes of 27gauge pars plana vitrectomy for a variety of posterior segment diseases

Article

Full-text available

Oct 2021
J Pakistan Med Assoc

Objective: To report outcomes of 27 gauge pars plana vitrectomy for the management of a variety of simple to complex posterior segment disorders. Methods: This retrospective cohort study was conducted at the Shifa International Hospital, Islamabad, Pakistan, and comprised data of all patients who underwent 27 gauge pars plana vitrectomy between July 1, 2015, and June 30, 2019, for a variety of indications. Data noted included age, gender, laterality, diagnosis, pre-operative visual acuity, date of surgery and surgical details, including operating time and complications. Best corrected visual acuity at 3 months was also recorded. Data was analysed using SPSS 21. Results: Of the 574 patients, 355(62%) were males and 219(38%) were females. The overall mean age was 55±16.9 years. There were total 665 eyes as 91(15.8%) patients underwent bilateral surgeries. The most common surgical indications were diabetic tractional retinal detachment 196(29.5%) and vitreous haemorrhage 191(28.7%). Mean operating time was 62± 37 minutes. With the exception of 0.34% cases where 20 gauge fragmatome was used, no case required conversion to 20 gauge system, while 25 gauge trocar was used for silicon oil injection. Per-operative complications included iatrogenic retinal tear 2(0.3%) eyes and supra choroidal silicon oil migration 1(0.15%) eye. Post-operative complications were raised intraocular pressure 7(1.05%), endophthalmitis 1(0.15%) eye, haemorrhagic occlusive retinal vasculitis 1(0.15%) eye and rhegmatogenous retinal detachment 2(0.3%) eyes. Mean best corrected visual acuity improved from 1.62± 0.68 to 0.4± 0.38 logarithm of minimum angle of resolution (p<0.001). Conclusion: The 27 gauge pars plana vitrectomy was found to be a safe and effective procedure for both simple and complex retinal pathologies requiring significant surgical manipulation. Keywords: Operative time, Retina, Visual acuity, Vitrectomy, Vitreoretinal surgery. (JPMA 71: 2570; 2021)

Endophthalmitis following Intravitreal Injection, Cataract Surgery, and Vitrectomy: Clinical Features and Visual Outcomes

Article

Full-text available

Sep 2021

Purpose: To describe and compare the clinical features and visual outcomes of endophthalmitis following intravitreal injections (IVI), cataract surgery, and pars plana vitrectomy (PPV). Methods: This is a single-centre, retrospective study. All included patients had acute postoperative endophthalmitis secondary to one of these three procedures. Visual acuity (VA), comorbidities, time to presentation, and treatment were assessed. The primary outcome was visual outcome. A poor outcome was considered if final VA was worse than or equal to counting fingers (CF) and a good outcome was classified as VA better than CF. Results: Over 12 years, a total of 61 patients were included. Twenty-seven cases were post-cataract endophthalmitis; twenty-five were post-IVI and nine post-PPV. Endophthalmitis post-PPV had a worse visual outcome (88.9% of patients with VA worse than or equal to CF 95% CI 51.3 to 100.0%) than endophthalmitis following cataract surgery (25.9% of patients with VA worse than or equal to CF 95% CI 11.0 to 39.9%) and the IVI subgroup (44.0% of VA worse than or equal to CF 95% CI 24.0 to 67.0%) (p=0.001 and p=0.047). There were no significant differences in the proportion of patients with a poor visual outcome between endophthalmitis following cataract surgery and IVI (p=0.171). Conclusions: The number of patients with poor visual outcomes following acute endophthalmitis was similar in endophthalmitis following IVI and cataract surgery, but better than endophthalmitis following vitrectomy.

Ten-year trends in the incidence, clinical profile and outcomes of acute-onset endophthalmitis following combined pars plana vitrectomy and sutureless, glueless and flapless scleral fixation of intraocular lenses

Article

Full-text available

May 2021
Int Ophthalmol

Purpose: To evaluate the frequency and outcomes of acute-onset endophthalmitis following combined pars plana vitrectomy and scleral fixation of intraocular lens. Methods: We evaluated patients undergoing a sutureless, glueless, flapless technique of scleral fixation of intraocular lenses (SFIOL) implantation for various causes of aphakia and documented the clinico-demographic data, microbiological profile and final outcome after acute endophthalmitis in this cohort of eyes. Results: The frequency of suspected acute endophthalmitis diagnosed post-surgery was 0.112% (4/3541 eyes), with culture-positive endophthalmitis frequency being 0.028% (1 eye), showing growth of Pseudomonas aeruginosa . Mean age of patients with endophthalmitis was 51.75±9.28 years and mean interval between surgery and acute endophthalmitis presentation was 10.25±9.6 days. Patients were managed with intravitreal antibiotics with or without core vitrectomy. Visual acuity of patients increased from baseline 1.43±0.32 logMAR (Snellen equivalent = 6/150) to 0.79±0.16 logMAR (Snellen equivalent = 6/36) after an average follow-up of 11±2 weeks. Conclusion : Endophthalmitis is a rare complication following SFIOL surgery, and all ophthalmic surgeons must be aware of this inadvertent possibility, since SFIOLs are gaining wider acceptability recently. Moreover, these cases of endophthalmitis may show a different pattern of microorganisms than post-cataract surgery endophthalmitis, however, with prompt diagnosis and effective timely management, favourable outcomes can be achieved.

Microincision vitrectomy surgery: Experimental visualization and quantification of vitreous contamination

Preprint

Full-text available

Jul 2020

Background: To visualize and quantify vitreous contamination following microincision vitrectomy surgery (MIVS) using an experimental vitreous contamination model (EVCM). Methods: Enucleated porcine eyes with fluoresbrite carboxylate microspheres applied to the conjunctival surface were used as a type 1 EVCM. Twenty-five- or 27-gauge (G) trocar cannulas were inserted through the conjunctiva and sclera, followed by the placing and opening of an infusion cannula. These procedures were monitored by an intraocular fiber catheter. Secondly, condensed microspheres were applied to an excised sheet of porcine sclera to serve as type 2 EVCM. Twenty-five- or 27-G trocar cannulas were inserted perpendicularly through the top of the sclera where the condensed microspheres were applied, an infusion cannula was inserted, 0.1 mL of saline solution injected through the infusion cannula, and samples collected. The fluorescence strength of samples was then measured using fluorophotometry. Results: We visually detected fluorescent microspheres in 10/10 eyes with 25-G and 10/10 with 27-G MIVS. In the experimental quantification study, each MIVS gauge value was significantly higher than the control (P<0.01). However, there was no significant difference between 25-G and 27-G MIVS. Conclusions: MIVS carries the risk of introducing contamination directly into the eyes when the trocar cannula is inserted and infusion cannula is opened, even when a 27-G MIVS is used. Our study has shown it is essential that the surgeon be aware of the possibility of introducing contamination from the conjunctiva at all times during MIVS.

Influence of Perfluorocarbon Liquids on Peripapillary Retinal Nerve Fiber–Layer Thickness Following Pars Plana Vitrectomy with Silicone Oil–Based Endotamponade

Article

Full-text available

Oct 2020
Clin Ophthalmol

Background Inner retina–layer modifications after pars plana vitrectomy (PPV) can be objectively assessed through spectral domain optical coherence tomography (SD-OCT). Methods This study explored prospectively changes in retinal nerve-fiber layer (RNFL) thickness with SD-OCT in eyes undergoing PPV with silicone oil–based tamponade with and without use of perfluorocarbon liquids (PFCLs) during the early postoperative phase (up to 3 months) at the Research Institute of Ophthalmology, Egypt. Results Thirty patients were recruited who underwent PPV and silicone oil–based tamponade for either retinal detachment or diabetic retinopathy between April 2019 and September 2019. Mean RNFL thickness showed no significant change during follow-up at the first week (102.90±30.68 mm), 1 month (107.30±32.27), or three months (105.90±36.68; p=0.46, 0.68). There were significant correlations noticed between RNFL thinning and axial length of eyes, intraocular pressure, and use of PFCLs during the follow-up period. Conclusion The RNFL tends to change postvitrectomy, but not significantly. Careful examination and consistent follow-up is required for postvitrectomy patients with larger axial length and intraoperative PFCL use.

Microincision vitrectomy surgery: experimental visualization and quantification of vitreous contamination

Article

Full-text available

Nov 2020
BMC Ophthalmol

Background To visualize and quantify vitreous contamination following microincision vitrectomy surgery (MIVS) using an experimental vitreous contamination model (EVCM). Methods Enucleated porcine eyes with fluoresbrite carboxylate microspheres applied to the conjunctival surface were used as a type 1 EVCM. Twenty-five- or 27-gauge (G) trocar cannulas were inserted through the conjunctiva and sclera, followed by the placing and opening of an infusion cannula. These procedures were monitored by an intraocular fiber catheter. Secondly, condensed microspheres were applied to an excised sheet of porcine sclera to serve as type 2 EVCM. Twenty-five- or 27-G trocar cannulas were inserted perpendicularly through the top of the sclera where the condensed microspheres were applied, an infusion cannula was inserted, 0.1 mL of saline solution injected through the infusion cannula, and samples collected. The fluorescence strength of samples was then measured using fluorophotometry. Results We visually detected fluorescent microspheres in 10/10 eyes with 25-G and 10/10 with 27-G MIVS. In the experimental quantification study, each MIVS gauge value was significantly higher than the control (P < 0.01). However, there was no significant difference between 25-G and 27-G MIVS. Conclusions MIVS carries the risk of introducing contamination directly into the eyes when the trocar cannula is inserted and infusion cannula is opened, even when a 27-G MIVS is used. Our study has shown it is essential that the surgeon be aware of the possibility of introducing contamination from the conjunctiva at all times during MIVS.

Microincision Vitrectomy Surgery: Experimental Visualization and Quantification of Vitreous Contamination

Preprint

Full-text available

Jul 2020

Purpose: To visualize and quantify vitreous contamination following microincision vitrectomy surgery (MIVS) using an experimental vitreous contamination model (EVCM). Methods: Enucleated porcine eyes with fluoresbrite carboxylate microspheres applied to the conjunctival surface were used as a type 1 EVCM. Twenty-five- or 27-gauge (G) trocar cannulas were inserted through the conjunctiva and sclera, followed by the placing and opening of an infusion cannula. These procedures were monitored by an intraocular fiber catheter. Secondly, condensed microspheres were applied to an excised sheet of porcine sclera to serve as type 2 EVCM. Twenty-five- or 27-G trocar cannulas were inserted perpendicularly through the top of the sclera where the condensed microspheres were applied, an infusion cannula was inserted, 0.1 mL of saline solution injected through the infusion cannula, and samples collected. The fluorescence strength of samples was then measured using fluorophotometry. Results: We visually detected fluorescent microspheres in 10/10 eyes with 25-G and 10/10 with 27-G MIVS. In the experimental quantification study, each MIVS gauge value was significantly higher than the control (P<0.01). However, there was no significant difference between 25-G and 27-G MIVS. Conclusions: MIVS carries the risk of introducing contamination directly into the eyes when the trocar cannula is inserted and infusion cannula is opened, even when a 27-G MIVS is used. Our study has shown it is essential that the surgeon be aware of the possibility of introducing contamination from the conjunctiva at all times during MIVS.

Is it necessary to use tobramycin-dexamethasone eye ointment prophylactically in eyes at the end of intraocular surgery?

Preprint

Full-text available

Jan 2020

Background: There are no data available regarding the complications associated with using antibiotic ointment at the end of intraocular surgery. This study aimed to explore the necessity of using ocular tobramycin-dexamethasone prophylactically at the end of intraocular surgery. Methods: This was a retrospective cohort study of patients who received intraocular surgery at Tianjin Medical University General Hospital from January 2015 to December 2017. The patients were grouped according to whether they received tobramycin-dexamethasone eye ointment or not after surgery. The Tobramycin dexamethasone eye ointment was sampled to observe bacterial contamination pathogens at 0.5, 1, 1.5, 2, 2.5, 3, 6, 8, 24, 36, 48, 72, and 168 h after being opened. Results: A total of 3811 eyes in 3811 patients (mean age of 63±12 years) were included: 2397 eyes that received prophylactic tobramycin-dexamethasone eye ointment and 1414 eyes that did not. The overall rate of endophthalmitis was 0.08% (3/3811) in our study, all in the eye ointment group (0.12%, 3/2397); no patients developed endophthalmitis in the non-ointment group (0%, 0/1414)(P=0.184). The anterior chamber reactions 1 day after surgery were more serious in the eye ointment group compared with the non-ointment group (all P<0.05), but there were no statistically significant differences at 1 month postoperatively (all P>0.05). The contamination rate was 0% at all time points over 7 days. Conclusion: We did not observe a statistically significant difference in the incidence of endophthalmitis in patients with or without prophylactic tobramycin-dexamethasone eye ointment. And tobramycin-dexamethasone eye ointment seemed to increase some side effects such as eye secretions increasing and foreign body feeling.

Is it necessary to use tobramycin-dexamethasone eye ointment prophylactically in eyes at the end of intraocular surgery?

Preprint

Full-text available

Jan 2020

Objective There are no data available regarding the complications associated with using antibiotic ointment at the end of intraocular surgery. This study aimed to explore the necessity of using ocular tobramycin-dexamethasone prophylactically at the end of intraocular surgery. Methods This was a retrospective cohort study of patients who received intraocular surgery at Tianjin Medical University General Hospital from January 2015 to December 2017. The patients were grouped according to whether they received tobramycin-dexamethasone eye ointment or not after surgery. The Tobramycin dexamethasone eye ointment was sampled to observe bacterial contamination pathogens at 0.5, 1, 1.5, 2, 2.5, 3, 6, 8, 24, 36, 48, 72, and 168 h after being opened. Results A total of 3811 eyes in 3811 patients (mean age of 63±12 years) were included: 2397 eyes that received prophylactic tobramycin-dexamethasone eye ointment and 1414 eyes that did not. The overall rate of endophthalmitis was 0.08% (3/3811) in our study, all in the eye ointment group (0.12%, 3/2397); no patients developed endophthalmitis in the non-ointment group (P=0.184). The anterior chamber reactions 1 day after surgery were more serious in the eye ointment group compared with the non-ointment group (all P<0.05), but there were no statistically significant differences at 1 month postoperatively (all P>0.05). The contamination rate was 0% at all time points over 7 days. Conclusion Prophylactic tobramycin-dexamethasone eye ointment did not decrease the risk of endophthalmitis after intraocular surgery. Preoperative antibiotics and standardized surgical disinfection procedures probably play important roles in the prevention of endophthalmitis.

Is It Time to Abandon Subconjunctival Antibiotics following Pars Plana Vitrectomy?

Article

Aug 2018
RETINA-J RET VIT DIS

The association between endophthalmitis risk following a variety of intra-ocular procedures and defensin gene profile

Article

May 2024

The Physiological Consequences of Vitreous Composition, Vitreous Opacity, and Removal of the Vitreous

Chapter

Jan 2024

Treatment of Proliferative Diabetic Retinopathy in 2023

Article

Dec 2023
Int Ophthalmol Clin

A comparative study of anatomical and functional outcomes after 20, 23 and 25 gauge pars plana vitrectomy in adult population at a tertiary care center in Rajasthan

Article

Full-text available

Sep 2023

Pars plana vitrectomy is the most common technique in vitreoretinal surgery that enables access to the posterior segment for treating conditions such as retinal detachment, vitreous hemorrhage, macular hole, endophthalmitis, dropped nucleus and dropped iol in a controlled closed system. Prospective, comparative study of patients, more than 18 years of age, who underwent pars plana vitrectomy for various vitreoretinal disease at J.L.N. Medical College, Ajmer, from October 2020 to March 2022,with no previous history of any vitreoretinal surgery. 96 eyes of 96 patients that underwent 20-gauge (n=32), 23-gauge (n=32) and 25-gauge (n=32) Pars plana vitrectomy were included in this study. The mean duration of surgery was significantly higher in the conventional 20-Gauge as compared to the micro incisional vitrectomy system. Mean Best corrected visual acuity (BCVA) improved significantly in all three groups at postoperative 3 months, no significant difference between the 3 groups. Re retinal detachment occurs in 6 eyes(2 eyes in each group). Recurrent vitreous hemorrhage occurs in 1 eye in 25-gauge and postoperative endophthalmitis occurs in 2 eyes(1 eye each in 20-gauge and 23-gauge). There was a similar rate of ocular hypertension in all three groups. Postoperatively 20-gauge showed significantly higher mean conjunctival hyperemia and subconjunctival hemorrhage compared to Sutureless microincisional vitrectomy surgery. Functional and anatomical outcomes assessed by BCVA and retinal status postoperatively seem to be comparable between 20,23 and 25-gauge vitrectomy systems. Sutureless microincisional vitrectomy surgery showed significantly shorter duration of surgery.

Opacidades vítreas sintomáticas

Article

Sep 2023

Introduction to Vitreoretinal Surgery 2

Chapter

Jul 2021

Thomas H. Williamson

Stop and examine all elements in the system.

Exogene Endophthalmitis – Rolle der mikrobiologischen Erreger auf das klinische Ergebnis

Thesis

Jan 2022

Alexander Bartsch

Objectives Endophthalmitis is one of the most devastating infections in ophthalmology and can lead to irreversible vision loss in the infected eye within hours to days of symptom onset. Therefore, immediate diagnosis and planning of further procedures by the ophthalmologist are essential. Therapeutically, either a pars plana vitrectomy with complete removal of the vitreous and extensive lavage of the interior of the eye or intravitreal administration of antibiotics should be performed as soon as possible. The discovery of antibiotics in the last century represented a milestone in medicine and triggered a revolution in the care of bacterial infections. However, with the widespread use there has been an alarming increase in antibiotic resistance. In the following, we will examine whether this trend can also be observed in ophthalmology in the specific case of endophthalmitis. Besides the presentation of important clinical and temporal parameters, changes in the causative pathogen spectrum will be analyzed and possible effects of antibiotic resistance on the visual outcome will be compared. Design & Methods This retrospective study gives an overview of important temporal parameters, clinical, histological and microbiological aspects, as well as the visual outcome of exogenous postoperative (n=68) and posttraumatic (n=10) endophthalmitis cases. A total of 78 patients between 2012 and 2020 who received surgical treatment for endophthalmitis at the University Eye Hospital Erlangen could be included. Three of enucleated eyes (n=4) were examined histopathologically and processed in detail. Furthermore, the morphology of the macula as well as the thickness of the peripapillary nerve fiber layer (RNFL) was analyzed by optical coherence tomography (OCT). Taking several parameters into account, a score was developed to describe the severity of morphological alterations. Observations & Results Overall, 67 % of the patients showed an improvement of visual acuity in the follow-up compared to the preoperative visual acuity. The average final visual acuity of 0.95 +/- 0.9 logMAR is low despite successful therapy and illustrates the severity of the disease. No significant increase in antibiotic resistance was detected during the study period. Pathogen detection by gram stain and microscopy, polymerase chain reaction (PCR), and cultural growth was 68 % in total, which is consistent with the average in the literature. The most common causative pathogen was the skin pathogen Staphylococcus epidermidis. In the group of patients with a proven microbiological pathogen, a significantly worse visual acuity was seen preoperatively and in the follow-up examination than in the group without evidence of the pathogen. In case of change of the postoperative antibiotic therapy due to resistant bacteria species not covered by the broad-spectrum antibiotics, the visual outcome was not statistically significantly worse compared to the eyes in which the detected pathogen was sensitive to the initial calculated therapy. The OCT examinations showed a significant association between positive pathogen detection and the presence of macula pucker, hyperdense structures on the inner limiting membrane (ILM), degeneration of the ellipsoid layer, and optic disc atrophy. Histopathologic sections showed that enucleation was necessary because of a massive inflammatory reaction with secondary alterations, and not because of unmanageable infection. Conclusions No significant difference in visual acuity increase of the groups with and without adjusted antibiotic regimen could be demonstrated. The documented morphologic retinal changes support the hypothesis that the adjustment of the calculated postoperative therapy after antibiogram has less influence on the visual outcome than the infection itself or the subsequent inflammatory cascade.

Postoperative endophthalmitis - a review of literature

Article

Dec 2020

Postoperative endophthalmitis is one of the most feared complications for ophthalmologists, and the number of infections after intraocular procedures have been increasing. Nonetheless, a prompt intervention can result in the recovery of vision. In the past, endophthalmitis after cataract surgery was accountable for the majority of cases but is becoming less frequent due to the progress of surgical techniques and demographic developments with a steadily increasing number of intravitreal injections. In this article, the different forms of postoperative endophthalmitis are assessed in terms of pathophysiology and their specific characteristics depending on their etiology.

Incidence of Management Changes at the Postoperative Day One Visit After Pars Plana Vitrectomy for Retinal Detachment

Article

Sep 2020

Purpose: To evaluate the incidence of unexpected management changes on the first day after pars plana vitrectomy for retinal detachment repair DESIGN: Retrospective cohort study PARTICIPANTS: All cases of pars plana vitrectomy (PPV) for rhegmatogenous or tractional retinal detachment with completed postoperative day one (POD1) and week one (POW1) visits were included. Methods: The medical and billing records of a large academic private practice were electronically queried for all cases of PPV for retinal detachment performed between January 1, 2017 and December 31, 2017. The preoperative consultation, operative report, and POD1 and POW1 (postoperative days 5-14) visits were reviewed. Main outcome measures: Incidence of unexpected management changes (change in or extended positioning, additional procedure, change in drop regimen, or shortened interval follow-up) at the POD1 visit after uncomplicated PPV for retinal detachment. Results: Overall, 418 surgeries from 364 eyes and 355 patients were included. Eleven cases (2.6%) had an intraocular pressure (IOP) over 30 mmHg at POD1. IOP lowering drops were prescribed for 30 cases (7.2%). Silicone oil tamponade was positively associated with high IOP at POD1 (RR = 3.23, 95% CI 0.96 -10.84, P = 0.06). No additional management changes were made besides treating elevated IOP. Conclusions: Management changes POD1 after vitrectomy for retinal detachment repair are relatively uncommon and were solely IOP related in this patient group. There may be flexibility regarding the type of POD1 encounter necessary, including an IOP check with an ophthalmic technician or non-retinal eye care provider. Larger, prospective studies are needed to better determine the most efficient follow-up routine.

Complications of vitreoretinal surgery

Article

Mar 2020

Purpose of review: The present article reviews the most common and most serious vision-threatening and life-threatening complications of vitreoretinal surgery. Recent findings: Serious complications after vitreroretinal surgery are rare. Endophthalmitis for example has recently been estimated to occur in 0.08% of small gague vitrectomy. Other complications such as cataract are almost unavoidable, becoming visually significant in up to 80% of patients. The introduction of smaller gauge vitrectomy systems has reduced surgical times, conjunctival scarring and inflammation, and the rate of some complications such as retinal tears. Ocular venous air embolism is an exceedingly rare complication that is potentially life threating and therefore important for all vitreoretinal surgeons to be aware of. Summary: Though vitreoretinal surgery is well tolerated and effective, it is inevitable that all surgeons will experience complications and are therefore best served by understanding the potential complications, strategies to reduce the likelihood of them occurring, and ways to address them when they do happen.

Incidence of acute postoperative endophthalmitis following macular surgery in France between 2006 and 2016

Article

Full-text available

Nov 2019

Purpose: To report the incidence of acute postoperative endophthalmitis (POE) after macular surgery in France between 2006 and 2016 and to identify associated factors. Methods: This retrospective database study included all hospital discharge records involving a surgical procedure for an epiretinal membrane or a macular hole in France from January 2006 to October 2016. Acute POE was identified by two codes in the tenth edition of the International Classification of Diseases within 42 days of a macular surgical procedure in the French national administrative database. Results: In France, 152 034 macular surgical procedures for epiretinal membranes or macular holes were recorded from 1 January 2006 to 31 October 2016. Suspected acute POE was reported in 381 cases. The incidence of POE was 0.25% overall, 0.30% for epiretinal membrane surgery and 0.14% for macular hole surgery. In multivariable Poisson regression analysis, epiretinal membrane surgery was associated with POE [incidence rate ratio (IRR), 2.24; 95% CI, 1.62-3.11; p < 0.001]. For epiretinal membrane surgery, the 2010-2011 period was significantly associated with a higher risk of POE (IRR, 1.66; 95% CI, 1.13-2.42; p = 0.03). Conclusion: The incidence of POE after macular surgery was 0.25% overall in France between 2006 and 2016 and twice higher for epiretinal membrane surgery than for macular hole surgery. For epiretinal surgery only, the incidence of POE was higher in 2010-2011 (period of the switch to transconjunctival vitrectomy) than in the rest of the study period.

Recent Developments in Glaucoma

Chapter

Oct 2019

Glaucoma describes a group of conditions characterised by the progressive loss of retinal ganglion cells and their axons resulting in specific patterns of optic nerve head damage and visual field loss. Recent developments in imaging, visual field analysis, medical management, and surgery are permitting earlier diagnosis, better methods of assessing progression, and an enhanced ability to treat the disease. The introduction of new imaging protocols and techniques including Swept-Source optical coherence tomography (OCT), OCT angiography, and adaptive optics are providing better methods of visualization and structural assessment. The impact of testing frequency, thresholding algorithms, and new analytical techniques are improving the detection and monitoring of vision loss in glaucoma. Promising advancements in pharmacotherapy include the introduction of new chemical entities with novel mechanisms of action, new formulations, and new delivery mechanisms. Recent studies have shed light on the efficacy of laser peripheral iridotomy, clear lens extraction in the management of angle closure, and the role of primary trabeculectomy or tube surgery in patients with uncontrolled glaucoma. Lastly, new minimally invasive glaucoma procedures have been introduced that aim to lower intraocular pressure with a better safety profile and faster recovery than conventional glaucoma surgery. This chapter provides an overview of recent developments in the management of glaucoma.

Recent Developments in Vitreo-Retinal Surgery

Chapter

Jan 2020

Vitreo-retinal surgical techniques have transformed since the introduction of pars plana vitrectomy in 1970. Advancements include smaller gauge instrumentation, faster cut rates, improved illumination methods, wider-field viewing systems, and the use of various tamponade agents and perfluorocarbon.

Small gauge vitrectomy: operative techniques

Article

May 2019

Purpose of review: This article reviews operative techniques and risks associated with microincision vitrectomy surgery. Recent findings: All three microincision vitrectomy surgery platforms (23, 25, and 27 gauge) are associated with both advantages and disadvantages, combined with similarly low rates of hypotony, endophthalmitis, corneal astigmatism, and postoperative inflammation. Summary: Hybrid-gauge vitrectomy, utilizing larger gauge MIVS cannulas, preserves surgeon access to benefits of both larger and smaller gauge MIVS platforms without compromising safety, efficacy, or efficiency.

CONJUNCTIVA-PRESSING FORCEPS DESIGNED TO CLOSE LEAKING SCLEROTOMY SITES DURING MICROINCISION VITRECTOMY

Article

Dec 2018
RETINA-J RET VIT DIS

Postoperative Complication Rates in 23- vs 25-Gauge Pars Plana Vitrectomy

Article

Jul 2018

Purpose The purpose of this study was to compare rates of clinically significant complications between 23- and 25-gauge pars plana vitrectomy (PPV) in vitreoretinal surgery. Methods Demographics, PPV indication, and surgical complications were reviewed. Patients with prior PPV or other retina surgery; cases requiring silicone oil removal, keratoplasty, or glaucoma valve implant; patients <18 years old; or patients with <4 months of follow-up were excluded. Comparative and descriptive statistics were used to evaluate the data. Results A total of 579 eyes met inclusion criteria, and their charts were reviewed. Demographics, PPV indication, follow-up time, and lens status were similar ( P > .05). A 23-gauge PPV was performed more frequently than a 25-gauge PPV (328 vs 251 eyes, respectively). Although rates of eyes with a clinically significant postoperative complication requiring surgical intervention were higher in 23-gauge PPV (112/325, 34.4%) than in 25-gauge PPV (54/250, 21.6%), PPVs indicated by rhegmatogenous retinal detachment were more common with 23-gauge PPVs (155/325, 47.7%) than with 25-gauge PPVs (37/250, 14.8%; P <.001) and were more likely to have postoperative complications; however, rates of recurrent retinal detachments were not different in the 2 cohorts ( P = .862). When controlling for differences in indication, there was a moderately higher rate of postoperative complications following 23-gauge PPV ( P = .063). Conclusions This retrospective review suggests that clinically significant complications are moderately more likely following 23-gauge PPV compared with 25-gauge PPV, even when the differences in surgical indication are considered.

ENDOPHTHALMITIS AFTER PARS PLANA VITRECTOMY: Efficacy of Intraoperative Subconjunctival Antibiotics

Article

Apr 2018
RETINA-J RET VIT DIS

Purpose: To examine rates of acute infectious endophthalmitis after pars plana vitrectomy (PPV) in eyes that received intraoperative subconjunctival antibiotics versus eyes that did not. Methods: A retrospective, nonrandomized, comparative case series of 18,886 consecutive cases of transconjunctival 23-, 25-, and 27-gauge PPV over a 5-year period was performed. The impact of prophylactic intraoperative subconjunctival antibiotics on the development of acute infectious postoperative endophthalmitis was examined. Results: Of 18,886 cases of PPV, 14,068 (74.5%) received intraoperative subconjunctival antibiotics, whereas 4,818 (25.5%) did not. Sixteen cases (0.085%, 1/1,176) of post-PPV endophthalmitis were identified. The incidence of endophthalmitis in eyes that received subconjunctival antibiotics was 0.078% (11/14,068 cases, 1/1,282), whereas the incidence in those that did not receive subconjunctival antibiotics was 0.10% (5/4,818 cases, 1/1,000). No statistically significant difference was identified in the incidence of endophthalmitis between those that received subconjunctival antibiotics and those that did not (P = 0.598). Microbial culture was performed in 11 cases with 6 culture-positive cases (5/8 cases that received subconjunctival antibiotics and 1/3 cases that did not). Conclusion: Prophylactic subconjunctival antibiotics were not associated with a significantly reduced rate of post-PPV endophthalmitis. With consideration of emerging multidrug-resistant bacteria, routine prophylactic subconjunctival antibiotics may not be justified.

INCIDENCE OF ENDOPHTHALMITIS AFTER VITRECTOMY: A Systematic Review and Meta-analysis

Article

Jan 2018
RETINA-J RET VIT DIS

Purpose: The purpose of this study was to review the literature reporting rates of postoperative endophthalmitis after pars plana vitrectomy and investigate whether modern microincision vitrectomy surgery (MIVS) increases the postoperative endophthalmitis rate, compared with traditional 20-gauge (20 G) vitrectomy. Methods: A comprehensive literature search was performed to identify studies describing the incidence of post-pars plana vitrectomy endophthalmitis. A meta-analysis of comparative studies reporting the endophthalmitis rates after MIVS versus 20 G vitrectomy was also conducted. Results: A total of 31 studies reported 199 endophthalmitis cases in 363,544 participants (0.05%). The incidence of endophthalmitis after 20 G vitrectomy was 0.04% (88/229,435), compared with 0.03% (8/27,326) after 23 G and 0.11% (33/29,676) after 25 G. The meta-analysis demonstrated that the incidence of endophthalmitis was higher after MIVS (23 G/25 G) compared with 20 G vitrectomy (odds ratio = 3.39, 95% confidence interval, 1.39-8.23). In a subgroup analysis, we also found an increased risk of endophthalmitis after 25 G compared with 20 G vitrectomy (odds ratio = 4.09, 95% confidence interval, 2.33-7.18), but not for 23 G versus 20 G (odds ratio = 1.14, 95% confidence interval, 0.47-2.78). Conclusion: The incidence of post-pars plana vitrectomy endophthalmitis was low, with no significant differences between 23 G MIVS and 20 G vitrectomy, but 25 G MIVS may result in a higher postoperative endophthalmitis rate.

Endophthalmitis after Pars Plana Vitrectomy A 20-and 25-Gauge Comparison

Article

Full-text available

Aug 2009

Recent retrospective analyses have suggested that postoperative endophthalmitis may be more frequent with 25- than 20-gauge pars plana vitrectomy (PPV). Because the infection risk may depend on the suturing status of the sclerotomy, and the perioperative anti-infection protocol, we compared the incidence rate of endophthalmitis after sutureless 25-gauge versus sutured 20-gauge PPV on a large cohort of patients operated with a standardized perioperative anti-infection protocol. Retrospective comparative case series. Consecutive patients who underwent 20- or 25-gauge PPVs at a single center over a multi-year period. We analyzed 3597 consecutive PPVs. Patients with a pre-PPV diagnosis of endophthalmitis, PPVs performed for implantation of drug delivery devices, or 25-gauge PPVs with all sclerotomies sutured closed were excluded. Patients with > or =1 week of follow-up were divided into 2 study groups by sclerotomy status at the end of surgery: the 20-gauge group had 3 sutured 20-gauge sclerotomies, and the 25-gauge group had > or =1 unsutured 25-gauge sclerotomy. Endophthalmitis was defined by clinical criteria independent of microbiological results. The incidence of endophthalmitis was compared between 25- versus 20-gauge groups. Of 3372 PPV surgeries meeting inclusion and exclusion criteria, 1948 and 1424 surgeries were 20- and 25-gauge PPVs, respectively. Average age (+/- standard deviation) of patients was 54.6 (+/- 22.6) and 64.4 (+/- 16.5) years in the 20- and 25-gauge PPV groups, respectively (P<0.0001). Median post-PPV follow-up time was not significantly different between the 2 groups (12.5 vs 13.0 months; P = 0.69). Endophthalmitis was observed in 1 patient (0.07%; 95% confidence interval, 0%-0.21%) from the 25-gauge group and none in the 20-gauge group (P = 0.42; Fisher exact test, 2-tailed). The use of air/gas endotamponade (P<0.0001) and intravitreal triamcinolone (P<0.001) was more common in 25- versus 20-gauge PPV. The incidence of endophthalmitis was low in both groups. We were unable to show a significant difference in the incidence of endophthalmitis between sutureless 25-gauge and sutured 20-gauge PPV, and conclude that a careful perioperative anti-infection protocol may reduce 25-gauge PPV endophthalmitis risk to that of 20-gauge PPV.

Endophthalmitis following 25-gauge vitrectomy [9]

Article

Full-text available

Dec 2005

Expanded Indications for 25-Gauge Transconjunctival Vitrectomy

Article

Full-text available

Sep 2005

We conducted 25-gauge (25G) transconjunctival vitrectomy to treat patients with various ocular diseases, and examined the possibility of expanding the indications for this system through combined use with 20G devices when needed. The records of 167 patients (169 eyes) who underwent vitrectomy in our hospital between April and June 2004 were studied. Vitrectomy had been conducted using the 20G or 25G transconjunctival vitrectomy system. In 7 of the 169 eyes (4%), the 20G system was initially selected. Vitrectomy could be performed using the 25G system alone in 150 eyes (89%), while 20G devices were used in combination with the 25G system in 12 (7%). None of the 25G scleral wounds were sutured, while all the 20G scleral wounds were sutured at the completion of surgery. Low intraocular tension was noted in 15 of 162 eyes (9%), but all these eyes recovered within 2 to 4 days. In two eyes with macular hole, retinal detachment occurred, but reattachment was achieved after reoperation. No extensive vitreoretinal hemorrhage or postoperative infection was observed. By combining the use of 20G devices, indications for the 25G system can be expanded. However, postoperative low ocular tension must be addressed by carefully considering surgical indications and prevention measures.

Ultrasound biomicroscopy findings of 25 G Transconjuctival Sutureless (TSV) and conventional (20G) pars plana sclerotomy in the same patient

Article

Full-text available

Feb 2006
BMC Ophthalmol

Transconjunctival Sutureless Vitrectomy (TSV) is a recent advancement in vitreo-retinal surgical techniques involving the use of 25 G instruments through self-sealing sclerotomies. It has been hypothesized that there may be less chance of vitreous and retinal herniation in the scleral wound as compared to conventional sclerotomy incision. However there are no reports on differences in 20 gauge and 25 gauge sclerotomies using ultrasound biomicroscopy (UBM). We report herein the differences in sclerotomies undertaken with 20 gauge (G) and 25 gauge instruments in the same patient. Ultrasound biomicroscopy of the sclerotomy sites was done in the same patient in whom both 20 G and 25 G sclerotomies had to be constructed during pars plana vitrectomy and the differences were studied. On day 2, we observed a wide gape at the site that had been enlarged using a 20G MVR blade. In contrast, the other two sites made transconjunctivally using the 25G trocar showed only a mild gape. Significant gape continued to persist at the subsequent evaluations on day 7 and day 14 only at the port, which had been enlarged. Healing of a 25 G sclerotomy is expectedly quite rapid, with inability to detect the site of sclerotomy in a short duration of 2 weeks post-operatively. This is as opposed to conventional sclerotomies, which might take up to 6-8 weeks post-operatively for complete opposition.

Results and complications of 100 consecutive cases of pars plana vitrectomy

Article

Jan 1991
RETINA-J RET VIT DIS

R.G. Michels

Endophthalmitis after Pars Plana Vitrectomy

Article

Dec 1977
AM J OPHTHALMOL

George W. Blankenship

In three cases of bacterial endophthalmitis following pars plana vitrectomy the important diagnostic findings included increased orbital pain, decreased visual acuity, and the presence of a hypopyon. Despite agressive antibiotic therapy, all three eyes became blind, and two progressed rapidly to phthisis.

National Outcomes of Cataract Extraction

Article

Aug 1991
ARCH OPHTHALMOL-CHIC

Jonathan Javitt

• We analyzed the likelihood of rehospitalization for endophthalmitis in 338 141 Medicare beneficiaries over age 65 years who were admitted to US hospitals for cataract extraction in 1984. This cohort represents approximately one half of all persons who underwent cataract extraction under the Medicare program in 1984. Extracapsular extraction was performed in 195 587 (58%) of cases, intracapsular cataract extraction in 99 971 (30%), and phacoemulsification in 28 474 (8%). The risk of rehospitalization for endophthalmitis in the year following surgery was 0.17% for intracapsular cataract extraction compared with 0.12% for extracapsular extraction or phacoemulsification (P<.002). The risk of endophthalmitis at 1 month was higher for intracapsular cataract extraction than for extracapsular extraction or phacoemulsification (0.11% vs 0.085%), although the difference did not reach statistical significance. Cataract surgery accompanied by anterior vitrectomy increased the 1-month risk of rehospitalization for endophthalmitis to 0.41%, more than a four-fold increase over that for cataract surgery alone (0.09%; P<.05). The rates of endophthalmitis at 1 year were 0.58% and 0.13%, respectively, for cataract surgery with anterior vitrectomy and cataract surgery alone (P<.0001). No significant differences in the rate of rehospitalization for endophthalmitis were observed based on the use of an intraocular lens, age, or race. Endophthalmitis within 1 year of surgery was 1.2 times more frequent in men than in women (0.16% vs 0.13%; P =.03). Overall, the likelihood of postoperative endophthalmitis from a national sample is consistent with case series previously reported.

Nosocomial Endophthalmitis Survey

Article

Feb 1991
OPHTHALMOLOGY

The authors reviewed the incidence of hospital-linked postoperative endophthalmitis at the Bascom Palmer Eye Institute between January 1, 1984 and June 30, 1989. After 30,002 intraocular surgical procedures, the following incidence of culture-proven endophthalmitis was observed: (1) extracapsular cataract extraction (ECCE) with or without intraocular lens (IOL) implantation—0.072% (17 of 23,625 cases); (2) pars plana vitrectomy—0.051% (1 of 1974 cases); (3) penetrating keratoplasty (PKP)—0.11% (2 of 1783 cases); (4) secondary IOL—0.30% (3 of 988 cases); and (5) glaucoma filtering surgery—0.061% (1 of 1632 cases). A statistically significant (P = 0.038, Fisher's exact test, two-tailed) increased incidence of endophthalmitis occurred, in diabetic (0.163%, 6 of 3686 cases) compared with nondiabetic (0.055%, 11 of 19939 cases) patients undergoing ECCE with or without IOL implantation. The authors also reviewed the incidence of postoperative endophthalmitis after intracapsular cataract extraction (ICCE) with and without IOL and observed an incidence of 0.093% (7 of 7552) in cases operated on between September 1, 1976 and December 31, 1982.

A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery 1 1 The new Transconjunctival Sutureless Vitrectomy System is disclosed to Bausch and Lomb Surgical, St. Louis, MO. The Microsurgery Advanced Design Laboratory (MADLAB) may receive royalties related to the sale of this and other instruments mentioned in the article

Article

Oct 2002

Objectives To introduce and evaluate the infusion and aspiration rates and operative times of the 25-gauge transconjunctival sutureless vitrectomy system (TSV)

Results and Complications of 100 Consecutive Cases of Pars Plana Vitrectomy

Article

Aug 1975
AM J OPHTHALMOL

We employed pars plana vitrectomy for several different indications in 100 eyes. In 51 eyes, the operation was performed for complications of pholiferative diabetic retinopathy. Improved visual acuity was our only criterion of success, and this varied widely depending on the specific indication forsurgery. Vision improved in all eight eyes undergoing anterior segment reconstruction and in none of three eyes with preoperative retinal detachment complicated by massive vitreous retraction. There was a high incidence of retinal tears complicating the operations in the series (37%). These retinal breaks could usually be closed at the time of the initial operation, and retinal detachment that could not be successfully managed developed in only four eyes.

National outcomes of cataract extraction: Endophthalmitis following inpatient surgery

Article

Sep 1991
ARCH OPHTHALMOL-CHIC

We analyzed the likelihood of rehospitalization for endophthalmitis in 338,141 Medicare beneficiaries over age 65 years who were admitted to US hospitals for cataract extraction in 1984. This cohort represents approximately one half of all persons who underwent cataract extraction under the Medicare program in 1984. Extracapsular extraction was performed in 195,587 (58%) of cases, intracapsular cataract extraction in 99,971 (30%), and phacoemulsification in 28,474 (8%). The risk of rehospitalization for endophthalmitis in the year following surgery was 0.17% for intracapsular cataract extraction compared with 0.12% for extracapsular extraction or phacoemulsification (P less than .002). The risk of endophthalmitis at 1 month was higher for intracapsular cataract extraction than for extracapsular extraction or phacoemulsification (0.11% vs 0.085%), although the difference did not reach statistical significance. Cataract surgery accompanied by anterior vitrectomy increased the 1-month risk of rehospitalization for endophthalmitis to 0.41%, more than a four-fold increase over that for cataract surgery alone (0.09%; P less than .05). The rates of endophthalmitis at 1 year were 0.58% and 0.13%, respectively, for cataract surgery with anterior vitrectomy and cataract surgery alone (P less than .0001). No significant differences in the rate of rehospitalization for endophthalmitis were observed based on the use of an intraocular lens, age, or race. Endophthalmitis within 1 year of surgery was 1.2 times more frequent in men than in women (0.16% vs 0.13%; P = .03). Overall, the likelihood of postoperative endophthalmitis from a national sample is consistent with case series previously reported.

Nosocomial endophthalmitis survey. Current incidence of infection after intraocular surgery

Article

Mar 1991
OPHTHALMOLOGY

The authors reviewed the incidence of hospital-linked postoperative endophthalmitis at the Bascom Palmer Eye Institute between January 1, 1984 and June 30, 1989. After 30,002 intraocular surgical procedures, the following incidence of culture-proven endophthalmitis was observed: (1) extracapsular cataract extraction (ECCE) with or without intraocular lens (IOL) implantation--0.072% (17 of 23,625 cases); (2) pars plana vitrectomy--0.051% (1 of 1974 cases); (3) penetrating keratoplasty (PKP)--0.11% (2 of 1783 cases); (4) secondary IOL--0.30% (3 of 988 cases); and (5) glaucoma filtering surgery--0.061% (1 of 1632 cases). A statistically significant (P = 0.038, Fisher's exact test, two-tailed) increased incidence of endophthalmitis occurred in diabetic (0.163%, 6 of 3686 cases) compared with nondiabetic (0.055%, 11 of 19,939 cases) patients undergoing ECCE with or without IOL implantation. The authors also reviewed the incidence of postoperative endophthalmitis after intracapsular cataract extraction (ICCE) with and without IOL and observed an incidence of 0.093% (7 of 7552) in cases operated on between September 1, 1976 and December 31, 1982.

Bacterial Endophthalmitis After Closed Vitrectomy

Article

Mar 1984
ARCH OPHTHALMOL-CHIC

Four cases of bacterial endophthalmitis occurred after more than 2,800 closed vitrectomies. Despite vigorous antibiotic therapy, all four eyes were lost. The poor outcome seems to result from difficulties in diagnosing this condition in its early stages. Important clinical indications, such as orbital pain, corneal edema and infiltrate, excessive intraocular inflammatory reaction, hypopyon, and diminished fundus reflex, are often masked by the usual postoperative course. According to our study, the incidence of endophthalmitis after closed vitreous surgery is 0.14%. Three of the four patients with endophthalmitis were diabetic. Our clinical findings are compared with those in the four other cases reported in the literature.

Endophthalmitis after pars plana vitrectomy. The Postvitrectomy Endophthalmitis Study Group

Article

Jun 1995
OPHTHALMOLOGY

To describe the clinical course and incidence of culture-proven postvitrectomy endophthalmitis in 18 patients from five academic centers and three private practices. Patients undergoing pars plana vitrectomy for recent trauma or endophthalmitis were excluded. The average age was 58 years (range, 21-85 year). Sixty-one percent of the patients (11/18) had diabetes mellitus. The indication for initial vitrectomy was vitreous hemorrhage (n = 10), macular epiretinal membrane (n = 3), recurrent retinal detachment with proliferative vitreoretinopathy (n = 2), retinal detachment with retinoschisis (n = 1), proliferative diabetic retinopathy with tractional retinal detachment (n = 1), and dislocated intraocular lens (n = 1). None of these eyes received prophylactic intraocular antibiotics during the vitrectomy. All eyes were treated with intraocular antibiotics after the diagnosis of postvitrectomy endophthalmitis was made. Final visual acuity ranged from 20/20 to no light perception and included five eyes with 20/50 or better visual acuity and 11 eyes with less than 5/200 visual acuity. Nine eyes had a final visual acuity of no light perception. Of the 16 eyes infected with a single organism, 71% (5/7) of eyes infected with coagulase-negative staphylococci retained 20/50 or better final visual acuity compared with no eyes (0/9) infected with other organisms (P = 0.005). Two eyes infected with both coagulase-negative Staphylococcus and Streptococcus had a final visual acuity of 20/400. Three eyes with a total hypopyon later had enucleation or evisceration. Based on the data from four medical centers, the incidence of endophthalmitis after pars plana vitrectomy performed over the last 10 years was 9/12,216 (0.07%). Endophthalmitis after vitrectomy is rare. Postvitrectomy bacterial endophthalmitis caused by organisms other than coagulase-negative staphylococci has a poor visual prognosis.

Antimicrobial pharmacokinetics in endophthalmitis treatment: studies of ceftazidime

Article

Feb 1993
Trans Am Ophthalmol Soc

Travis A. Meredith

Ceftazidime has pharmacokinetic advantages for treatment of endophthalmitis caused by gram negative-organisms by intravenous administration. Additionally, its spectrum of coverage for these organisms and its relatively low toxicity after intraocular injection are favorable attributes. These studies demonstrate that inflammation leads to a significant reduction of the blood-ocular barriers to ceftazidime. This increased permeability shortens the half-life of the drug after intraocular injection but allows a significant penetration into the eye after a single intravenous dose so that therapeutic levels are achieved. Ceftazidime appears to be removed by both the anterior and the posterior route without active transport. The experiments demonstrate the importance of the vitreous as a barrier to achieving significant concentration of antibiotic within the eye after intravenous administration and confirm the importance of the vitreous in prolonging the half-life of drugs injected intravitreally. Finally the results emphasize that the pharmacokinetic behavior of drugs for treatment of endophthalmitis must be assessed in inflamed eyes both with and without intact vitreous, since these factors play a large role in drug availability and concentration in the vitreous cavity and are the major variables in the clinical setting.

Acute-Onset Postoperative Endophthalmitis: Review of Incidence and Visual Outcomes (1995-2001)

Article

Sep 2002
Ophthalmic Surg Laser

To determine the incidence rate of acute-onset postoperative endophthalmitis and to assess visual acuity outcomes after treatment from the most recent 7 years (1995-2001) compared with the previous 11 years (1984-1994) among patients undergoing intraocular surgery at the same institution. The medical records were reviewed of all patients undergoing intraocular surgery at the Bascom Palmer Eye Institute between January 1, 1995 and December 31, 2001. The 7-year incidence rate of acute-onset postoperative endophthalmitis was 0.05% (17 of 35,916 intraocular surgeries). The number of patients with endophthalmitis (incidence) and their median final visual acuity for each surgical category are as follows: cataract extraction: 8/21,972 (0.04%) - 20/100; glaucoma surgery: 4/1,970 (0.2%) - 20/70; penetrating keratoplasty: 2/2,362 (0.08%) - light perception; pars plana vitrectomy: 2/7,429 (0.03%) - hand movements; secondary intraocular lens placement: 1/485 (0.2%) - 20/40. Of the 8 cases of endophthalmitis after cataract surgery, 6 cases occurred after phacoemulsification and 2 of these cases had a dear corneal sutureless incision. The most recent 7-year incidence rate of acute-onset postoperative endophthalmitis is significantly lower than that of the previous 11 years (0.05% versus 0.09%; = 0.031) at the same institution. Visual acuity outcomes after treatment were generally better in cataract surgery, glaucoma surgery, and secondary intraocular lens categories compared to pars plana vitrectomy and penetrating keratoplasty categories.

A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery

Article

Nov 2002
OPHTHALMOLOGY

To introduce and evaluate the infusion and aspiration rates and operative times of the 25-gauge transconjunctival sutureless vitrectomy system (TSV) DESIGN: In vitro experimental and comparative interventional study. Twenty eyes of 20 patients underwent a variety of vitreoretinal procedures using the 25-gauge TSV, including idiopathic epiretinal membrane (n = 10), macular hole (n = 4), rhegmatogenous retinal detachment (n = 3), branch retinal vein occlusion (n = 2), diabetic vitreous hemorrhage (n = 1), and 20 cases similar in diagnosis and severity were matched to provide comparison between duration of individual portions of the surgical procedures with the existing 20-gauge vitrectomy system. Description of the 25-gauge TSV is provided; infusion and aspiration rates of the 25-gauge and standard 20-gauge vitrectomy system were measured in vitro using balanced saline solution and porcine vitreous for several levels of aspirating power and bottle height, and operating times of individual portions of surgical procedures were measured for the 25-gauge and 20-gauge vitrectomy system. Infusion, aspiration rates, and operative times of the 20-gauge and 25-gauge vitrectomy system. Infusion and aspiration rates of the 25-gauge TSV system were reduced by an average of 6.9 and 6.6 times, respectively, compared with the 20-gauge system when balanced saline solution was used. The average flow rate of the Storz 25-gauge cutter (at 500 mmHg, 1500 cuts per minute [cpm]) was 40% greater than that of the 20-gauge pneumatic cutter (at 250 mmHg, 750 cpm) but about 2.3 times less than the 20-gauge high-speed cutter (at 250 mmHg, 1500 cpm). Mean total operative time was significantly greater for the 20-gauge high-speed cutter (26 minutes, 7 seconds) than for the 25-gauge vitrectomy system (17 minutes, 17 seconds) (P = 0.011). Although the infusion and aspiration rates of the 25-gauge instruments are lower than those for the 20-gauge high-speed vitrectomy system, the use of 25-gauge TVS may effectively reduce operative times of select cases that do not require the full capability of conventional vitrectomy.

Dynamic morphology of sutureless cataract wounds - Effect of incision angle and location

Article

Apr 2004
SURV OPHTHALMOL

Sutureless cataract surgery has been growing in popularity over the last decade. These clear corneal incisions allow for rapid visual recovery after phacoemulsification, but may be associated with an increased risk of endophthalmitis. The purpose of this study was to evaluate the effect of intraocular pressure (IOP), location, and angle of cataract incisions on wound apposition and sealing in postmortem globes. This was an ex vivo laboratory investigation of 20 rabbit eyes and 14 human eyes. Self-sealing clear corneal, limbal, and scleral incisions were created and IOP was controlled with an infusion cannula. Incisions were made at a variety of angles. Optical coherence tomography was used to image the incisions in real time as the IOP was varied by raising and lowering the infusion bottle, so as to simulate the variation in IOP occurring with blinking or squeezing of the eye. With each type of incision, optical coherence tomography demonstrated the dynamic nature of cataract wound morphology as IOP was varied. Higher IOPs, in general, were associated with more tightly sealed wounds than lower IOPs, but this varied according to the location and angle of the incisions. More perpendicular incisions, relative to the surface tangent, sealed less well than incisions created at smaller angles at higher levels of IOP; At lower IOPs, the reverse relationship was observed such that more perpendicular incisions sealed less well than smaller incision angles. Changes in IOP may result in variable and sometime poor wound apposition in sutureless cataract incisions. The type of incision and angle of the incision may affect the likelihood of inoculation of the aqueous humor with potentially pathogenic bacteria. For each type of incision, there may be a critical angle at which the incision is better able to withstand fluctuations in IOP.

Inflow of ocular surface fluid through clear corneal cataract incisions: A laboratory model - Response

Article

Sep 2004
AM J OPHTHALMOL

To evaluate the self-sealing properties of standard clear corneal cataract incisions during two events: (1) application of mechanical external pressure, or (2) controlled fluctuation of intraocular pressure (IOP). Laboratory investigation. Eight fresh human donor globes were prepared for Miyake video microscopy. A standard two-plane 3-mm clear corneal incision was created and a 3 x 3-mm sponge soaked with India ink was placed on the wound surface. One globe with a sutured corneal wound served as the control. A transcleral cannula was inserted and connected to a bottle of saline. Intraocular pressure was modified varying the bottle height. External pressure was applied through manual contact on different regions of cornea. Four of seven eyes demonstrated intraocular presence of ink, three of them after external manipulation and another after varying the IOP. Self-sealing properties of unsutured clear corneal wounds were compromised in our model. These data may give insight into the possible mechanisms involved in the inflow of extraocular fluid into the eye through clear corneal cataract incisions.

Endophthalmitis after pars plana vitrectomy: Incidence, causative organisms, and visual acuity outcomes

Article

Dec 2004
AM J OPHTHALMOL

To investigate the incidence, causative organisms, and visual acuity outcomes associated with endophthalmitis after pars plana vitrectomy. Retrospective, noncomparative, consecutive case series. The medical records were reviewed of all patients who developed acute-onset postoperative endophthalmitis (within 6 weeks of surgery) after pars plana vitrectomy at Bascom Palmer Eye Institute between January 1, 1984 and December 31, 2003. During the 20-year study interval, the overall incidence rate of postvitrectomy endophthalmitis was 0.039% (6/15,326). Cultured organisms were Staphylococcus aureus (n = 3), Proteus mirabilus (n = 1), and Staphylococcus epidermidis/Pseudomonas aeruginosa (n = 1); one case was culture-negative. Visual acuity after treatment for endophthalmitis ranged from 2/200 to no light perception, with a final vision of light perception or no light perception in four of six (67%) eyes. The incidence of endophthalmitis after pars plana vitrectomy is low but the visual acuity outcomes after treatment are generally poor.

Longer-term Outcomes of Transconjunctival Sutureless 25-gauge Vitrectomy

Article

Jun 2005
AM J OPHTHALMOL

To report longer-term outcomes in eyes undergoing 25-gauge transconjunctival sutureless vitrectomy. Retrospective, noncomparative, case series. Chart review of the initial 45 consecutive patients (45 eyes) that underwent TSV by one surgeon (T.S.H.) for idiopathic epiretinal membrane (n = 15), refractory diabetic macular edema (n = 11), idiopathic macular hole (n = 10), and nonclearing vitreous hemorrhage (n = 9). All patients had at least 6-month follow-up. Main outcome measures included visual acuity (VA), intraocular pressure, intraoperative complications, and postoperative complications. Mean follow-up was 13 months (range 6 to 25 months). Mean overall preoperative VA vs last postoperative VA was 20/229 and 20/65, respectively (P < .0001). Statistically significant VA improvement was seen for each patient subgroup. Mean preoperative intraocular pressure was 16.9 mm Hg (range 10-26 mm Hg). On postoperative day 1, week 1, and week 4, median intraocular pressure was 14.6 mm Hg (range 8-17 mm Hg), 17.6 mm Hg (range 8-38 mm Hg), and 17.7 mm Hg (range 9-33 mm Hg), respectively. No intraoperative complications occurred. Postoperative complications were 1 inferior retinal detachment (2.2%) 4 weeks after macular hole repair, 1 macular hole (2.2%) 6 months after epiretinal membrane peel, and 23 worsening cataracts in 29 phakic eyes (79.3%). Less surgically complex vitreoretinal pathology may be successfully repaired with TSV. After a mean follow-up of more than 1 year, minimal complications were seen, and none was specifically related to the sutureless nature of the procedure.

Outcomes of 140 Consecutive Cases of 25-Gauge Transconjunctival Surgery for Posterior Segment Disease

Article

Jun 2005

To evaluate the safety and efficacy of 25-gauge instrumentation for a variety of vitreoretinal conditions on previously nonvitrectomized eyes. Single-center, retrospective, interventional case series. One-hundred forty eyes of 140 patients were evaluated at the Doheny Retina Institute from July 2002 to July 2003. All patients underwent surgical procedures using the Millennium 25-gauge Transconjunctival Standard Vitrectomy system. Twenty eyes (14.3%) underwent procedures without vitrectomy. Postoperative visual acuity (VA), intraocular pressure, surgical time, postoperative inflammation, complications, and number of sutured sites. No intraoperative complications were noted. No cases required conversion to 20-gauge machines. Ten cases (7.1%) involved single-site sclerotomy suture placement due to bleb formation at the conclusion of the procedure, but 5 of these entry sites were enlarged to facilitate larger instrumentation for tissue manipulation. Median VA improved from 20/250 (logarithm of the minimum angle of resolution, 1.08+/-0.47) preoperatively to 20/60 (0.47+/-0.30) (P<0.0001) at final visit. Mean follow-up was 33.8+/-9.7 weeks, and all eyes were observed for a minimum of 12 weeks. Mean total surgical time was 17.4+/-6.9 minutes. Intraocular pressures remained stable throughout the postoperative course. Five eyes (3.8%) presented on day 1 with shallow choroidal detachments, but all resolved by day 7, and none required volume infusion during the postoperative period. All but one of these cases was within the first 50 procedures performed. No detectable inflammation was noted in any eyes by 4 weeks postoperatively. No case of retinal detachment or endophthalmitis was recorded. Transconjunctival surgery using 25-gauge instrumentation may hasten postoperative recovery by decreasing overall surgical time and postoperative inflammation. Procedures requiring minimal intraocular manipulation did not require sutures and, thus, may be better suited for this surgical modality.

Cohort study of 27 cases of endophthalmitis at a single institution

Article

Apr 2005

To identify potential risk factors associated with post-cataract surgery bacterial endophthalmitis. The John A. Moran Eye Center, Salt Lake City, Utah, USA. This retrospective cohort study consisted of patients who had surgery for cataract(s) at this eye hospital. A 10% sampling of all patients operated on for cataract surgery from January 1, 1996, to December 31, 2002, were compared with all cases of postcataract surgery bacterial endophthalmitis during this same time period at this institution. The main outcome measure(s) included surgical complication, first postoperative day wound leak, incision placement and location, intraocular lens material, whether a suture was placed, antibiotic used, collagen shield use, and whether the eye was patched. A total of 1525 patients were in the control cohort, and there were 27 cases of endophthalmitis. In a multivariate regression analysis, the factors found to be statistically associated with endophthalmitis were (1) wound leak on the first postoperative day (odds ratio [OR] 44 +/- 42; confidence interval [CI] 6.85 to 287; P<.001); (2) capsular or zonular surgical complication (OR 17.2 +/- 14.2; CI 3.44 to 86.4; P=.001); (3) topical antibiotic started the day after surgery rather than the day of surgery (OR 13.7 +/- 12.9; CI 2.17 to 90.9; P=.005); (4) use of ciprofloxacin rather than ofloxacin topically after surgery (OR 5.3 +/- 3.6; CI 1.41 to 20.0; P=.014); (5) not patching after surgery (OR 7.1 +/- 5.6; CI 1.47 to 36.4; P=.015); and (6) not placing a collagen shield soaked in antibiotic (OR 2.7 +/- 1.3; CI 1.06 to 7.14 P=.037). In sutureless cataract surgery, surgical complications and wound leak on the first postoperative day were most strongly associated with endophthalmitis.

ASCRS White Paper: What is the association between clear corneal cataract incisions and postoperative endophthalmitis?

Article

Oct 2006

Endophthalmitis after 25-gauge transconjuctival sutureless vitrectomy

Article

Oct 2006
RETINA-J RET VIT DIS

Acute-onset postoperative endophthalmitis: review of incidence and visual outcomes

Jan 1995
373-8

Eifrig
Cwg
Flynn
Hw
Scott
Iu

Eifrig CWG, Flynn HW, Scott IU. Acute-onset postoperative endophthalmitis: review of incidence and visual outcomes (1995–2001). Ophthalmic Surg Lasers 2002;33:373– 8.

Incidence of Endophthalmitis after 20- and 25-Gauge Vitrectomy

Abstract

No full-text available

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