Abstract
Purpose
To report the safety and efficacy of 23-gauge (23-G) transconjunctival vitrectomy (TSV) in the surgical management of postoperative endophthalmitis.
Materials and Methods
Ten consecutive patients underwent a 23-G TSV in 2008–2010 after cataract surgery (n = 5) or filtrating surgery (n = 5), and were prospectively studied with a minimum follow-up of 6 months. TSV was performed within a median delay of 1 day after the diagnosis, after one or two injections of intravitreal antibiotics (vancomycin, ceftazidime). Conventional cultures (brain heart infusion media) and/or panbacterial PCR were performed on aqueous humor and/or vitreous samples.
Results
Initial visual acuity was less than or equal to hand motion in all cases, and clinical findings included hypopyon (80%), pupillary fibrin membrane (80%), and dense vitreitis (4+, 100%). The bacteria identified were Gram-positive cocci in 60% of the cases (coagulase-negative staphylococci, 20%; streptococcus, 40%) and Gram-negative bacilli in 10% (moraxella lacunata). All patients had central and peripheral vitrectomy (mean duration, 58.6 ± 16 min). No intraoperative complications were noted. Two patients developed retinal detachment postoperatively and were reoperated. The final visual vision was 20/400 for two patients and 20/50 or better for the other patients.
Conclusion
23-G TSV allows the surgeon to meet the same objectives as the 20-G technique for the treatment of endophthalmitis.
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References
Kresloff MS, Castellarin AA, Zarbin MA (1998) Endophthalmitis. Surv Ophthalmol 43(3):193–224
Endophthalmitis Vitrectomy Study Group (1995) Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol 113(12):1479–1496
Hikichi T, Matsumoto N, Ohtsuka H, Higuchi M, Matsushita T, Ariga H, Kosaka S, Matsushita R (2009) Comparison of one-year outcomes between 23- and 20-gauge vitrectomy for preretinal membrane. Am J Ophthalmol 147(4):639e1–643e1
Wimpissinger B, Kellner L, Brannath W, Krepler K, Stolba U, Mihalics C, Binder S (2008) 23-gauge versus 20-gauge system for pars plana vitrectomy: a prospective randomised clinical trial. Br J Ophthalmol 92(11):1483–1487
Parolini B, Prigione G, Romanelli F, Cereda MG, Sartore M, Pertile G (2010) Postoperative complications and intraocular pressure in 943 consecutive cases of 23-gauge transconjunctival pars plana vitrectomy with 1-year follow-up. Retina 30(1):107–111
Eckardt C (2005) Transconjunctival sutureless 23-gauge vitrectomy. Retina 25(2):208–211
Tan CS, Wong HK, Yang FP, Lee JJ (2008) Outcome of 23-gauge sutureless transconjunctival vitrectomy for endophthalmitis. Eye 22(1):150–151
Peyman GA (2004) In:Peyman GA, Lee PV, Seal DV (eds) Endophthalmitis: diagnosis and treatment. Taylor & Francis, Oxford, pp 90–91
Chiquet C, Cornut PL, Benito Y, Thuret G, Maurin M, Lafontaine PO, Pechinot A, Palombi K, Lina G, Bron A, Denis P, Carricajo A, Creuzot C, Romanet JP, Vandenesch F (2008) Eubacterial PCR for bacterial detection and identification in 100 acute postcataract surgery endophthalmitis. Invest Ophthalmol Vis Sci 49(5):1971–1978
Woo SJ, Park KH, Hwang JM, Kim JH, Yu YS, Chung H (2009) Risk factors associated with sclerotomy leakage and postoperative hypotony after 23- gauge transconjunctival sutureless vitrectomy. Retina 29(4):456–463
Thompson WS, Smiddy WE, Flynn HW Jr, Rubsamen PE (1996) Outcome of functioning filtering blebs after pars plana vitrectomy. Ophthalmic Surg Lasers 27(5):367–373
Doft BM, Kelsey SF, Wisniewski SR (2000) Retinal detachment in the endophthalmitis vitrectomy study. Arch Ophthalmol 118(12):1661–1665
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Almanjoumi, A.M., Combey, A., Romanet, J.P. et al. 23-gauge transconjunctival sutureless vitrectomy in treatment of post-operative endophthalmitis. Graefes Arch Clin Exp Ophthalmol 250, 1367–1371 (2012). https://doi.org/10.1007/s00417-012-1926-7
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DOI: https://doi.org/10.1007/s00417-012-1926-7