Endophthalmitis After Pars Plana Vitrectomy

Wu, Lihteh; Berrocal, María H.; Arévalo, J. Fernando; Carpentier, Cristian; Rodriguez, Francisco J.; Alezzandrini, Arturo; Farah, Michel Eid; Roca, José A.; Maia, Maurício; Saravia, Mario; Morales-Cantón, Virgilio; Graue-Wiechers, Federico; Cardillo, J.A.

doi:10.1097/iae.0b013e318203c183

Cited by 70 publications

(31 citation statements)

References 23 publications

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“…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.…”

Section: Discussionmentioning

confidence: 65%

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

2014

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Purpose: This study compared clinical outcomes and complications between 23-gauge (23g) and 25-gauge (25g) transconjunctival sutureless vitrectomy in patients with proliferative diabetic retinopathy. Study Design: It was a retrospective study using data prospectively defined and collected. 80 eyes underwent 23g transconjunctival sutureless vitrectomy, and 80 eyes underwent 25g surgery using the same vitrectomy system by one surgeon. Primary outcome measures were best-corrected visual acuity, intraocular pressure (IOP), and incidence of intraoperative and postoperative complications. Results: Vision was significantly improved after intervention in both groups (p ≥ 0.0001). There was no significant difference in visual outcomes between the groups (p = 0.43) or in the type and frequency of retinal breaks occurring during surgery (p = 0.63). The 23g group had significantly more patients with a day 1 IOP of <6 mm Hg (p = 0.034) and significantly more patients requiring a sclerostomy suture postoperatively (p = 0.014). Conclusion and Message: Both gauges are equally effective for the treatment of proliferative diabetic retinopathy.

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Section: Discussionmentioning

confidence: 65%

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

2014

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“…Beveled incisions and newer vitrectomy systems have been introduced in an attempt to reduce the risk of postoperative hypotony and related complications. These have lowered the risk of hypotony, and may account for recent reports that small incision postoperative endophthalmitis rates are currently low (0.02%) and comparable with endophthalmitis rates following 20-gauge vitrectomy 9–11. However, hypotony remains a frequent complication following 25-gauge vitrectomy surgery.…”

Section: Introductionmentioning

confidence: 94%

Use of 25% sulfur hexafluoride gas mixture may minimize short-term postoperative hypotony in sutureless 25-gauge pars plana vitrectomy surgery

Barak¹,

Heroman²,

Schaal³

2013

OPTH

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BackgroundThe purpose of this study was to compare postoperative intraocular pressures and percentage of vitreous cavity gas fill one day following 25-gauge pars plana vitrectomy with 20% versus 25% sulfur hexafluoride (SF6) gas fill.MethodsThis was a retrospective review of 187 consecutive cases of 25-gauge pars plana vitrectomy with complete fluid/gas exchange. The main outcome measures included percentage of gas fill of the vitreous cavity and intraocular pressure on postoperative day one.ResultsFifty eyes underwent 25-gauge pars plana vitrectomy with 20% SF6 tamponade and 137 with 25% SF6 tamponade. On postoperative day one in the 20% SF6 group, there were five (10%) patients with hypotony (intraocular pressure ≤ 5 mmHg) and none in the 25% SF6 group. Mean intraocular pressure was 9 ± 2.5 mmHg and 16.8 ± 2.4 mmHg for the 20% SF6 and 25% SF6 groups, respectively (P < 0.01). None of the patients had postoperative intraocular pressure > 23 mmHg. Mean vitreous cavity gas fill on postoperative day one was 70.7% ± 10% in the 20% SF6 group and 89.5% ± 2.2% in the 25% SF6 group (P < 0.01). There was no difference in the number of phakic patients needing cataract surgery between the groups.ConclusionA slightly expansile concentration of 25% SF6 gas can be safely and beneficially used in 25-gauge vitrectomy surgery to increase the amount of gas fill in the vitreous cavity and prevent postoperative hypotony.

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“…Initially, narrow-gauge vitrectomy was thought to be associated with a higher incidence of endophthalmitis than 20-gauge PPV; however, this has not proven to be true. 148, 149 …”

Section: Treatment Optionsmentioning

confidence: 99%

Idiopathic vitreomacular traction and macular hole: a comprehensive review of pathophysiology, diagnosis, and treatment

Steel

Lotery

2013

Eye

209

166

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Posterior vitreous detachment (PVD) is a common phenomenon in the aging eye. However, this may be complicated by persistent symptomatic vitreomacular adhesions that exert tractional forces on the macula (vitreomacular traction; VMT). VMT itself may be associated with epiretinal membrane formation and the development of idiopathic macular holes (IMH). Such pathologies may cause visual disturbances, including metamorphopsia, photopsia, blurred vision, and decreased visual acuity, which impact an individual's quality of life. Technologies such as optical coherence tomography allow an increasingly more accurate visualisation of the macular anatomy, including quantification of macular hole characteristics, and this facilitates treatment decision-making. Pars plana vitrectomy remains the primary treatment option for many patients with VMT or IMH; for the latter, peeling of the inner limiting membrane (ILM) of the retina has shown improved outcomes when compared with no ILM peeling. The development of narrow-gauge transconjunctival vitrectomy systems has improved the rate of visual recovery following surgery. Ocriplasmin, by degrading laminin and fibronectin at the vitreoretinal interface, may allow induction of PVD in a non-invasive manner. Indeed, clinical studies have supported its use as an alternative to surgery in certain patient populations. However, further research is still needed with respect to greater understanding of the pathophysiology underlying the development of VMT and IMH.

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Endophthalmitis After Pars Plana Vitrectomy

Abstract: Small-gauge transconjunctival PPV does not appear to increase the rates of post-PPV endophthalmitis.

Cited by 70 publications

References 23 publications

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

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

Use of 25% sulfur hexafluoride gas mixture may minimize short-term postoperative hypotony in sutureless 25-gauge pars plana vitrectomy surgery

Idiopathic vitreomacular traction and macular hole: a comprehensive review of pathophysiology, diagnosis, and treatment

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