A prospective and nationwide study investigating endophthalmitis following pars plana vitrectomy: incidence and risk factors

Abstract

Background/aims This is the first nationwide prospective study to investigate the incidence and risk factors of endophthalmitis following pars plana vitrectomy (PPV). Methods This was a prospective, nationwide casecontrol study. Cases of presumed infectious endophthalmitis within 6 weeks of PPV were reported via the established British Ophthalmological Surveillance Unit. The surveillance period was 2 years. Controls (patients who had PPV but no endophthalmitis) were recruited from nine randomly selected UK centres. Results 37 reports were received and 28 cases met the diagnostic criteria for presumed infectious endophthalmitis following PPV. The incidence of endophthalmitis following PPV was 28 cases per 48 433 PPVs (1 in 1730 with a 95% CI of 1 in 1263 to 1 in 2747). 272 controls were randomly recruited from nine UK centres. Smaller gauge port sizes were not found to be a risk. Immunosuppression (OR 19.0, p=0.001) and preoperative topical steroids (OR 131.4, p<0.001) increased the endophthalmitis risk. Operating for retinal detachment was associated with a reduced risk of endophthalmitis (OR 0.10, p=0.005). Conclusions Endophthalmitis following PPV is rare. Operating with smaller gauge port sizes does not increase the risk of endophthalmitis.

Endophthalmitis After Pars Plana Vitrectomy

“…Our observed rate of postvitrectomy endophthalmitis is similar to the one reported in the UK nationwide surveillance study at 0.058%. 12 Various risk factors have been proposed to be responsible for endophthalmitis after PPV. One important factor is inadequate wound closure in sutureless PPV surgeries due to a propensity for wound leak and subsequent intraocular ingress of surface microorganisms.…”

23-Gauge versus 25-Gauge Vitrectomy for Proliferative Diabetic Retinopathy: A Comparison of Surgical Outcomes

“…Earlier research found that rates were increased in smaller-gauge surgery [30]. However, more recent and larger studies have found no significant difference in the rate of endophthalmitis with smaller-gauge surgery [31,32]. It is likely that these differing conclusions reflect the evolution of small-gauge surgery: improving surgical technique and advancing technology have perhaps resulted in a decreasing incidence of endophthalmitis.…”

Vitrectomy for primary symptomatic vitreous opacities: an evidence-based review

“…The patient had a pre-PPV visual acuity of 6/9, which worsened after the endophthalmitis to 6/24 at 9 months partially limited by the nuclear sclerotic cataract. Similarly, Park et al 42 have published a large, prospective nation-wide study looking at endophthalmitis after PPV in UK. In their series, 28 out of a total of 48 433 eyes (1 in 1730) undergoing vitrectomy developed endophthalmitis.…”

“…21 Similarly, there have been two separate reports of endophtalmitis following PPV for floaters as well. 41,42 Table 1 summarises all the major studies on PPV for SVO.…”