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Diabetic Retinopathy Highlights from Retina/Vitreous Free Papers
Incidence of Endophthalmitis For 25-gauge Vitrectomy
| Sunday, November 12, 2006 |
| Derek Y Kunimoto, MD, JD, Richard S Kaiser, MD
The endophthalmitis outcomes of 8601 consecutive pars plana vitrectomies (PPV) performed at Wills Eye Hospital were reviewed. A total of 8 eyes developed endophthalmitis, none of which had received preoperative or postoperative antibiotic treatment. However, an unexpected 12-fold difference in endophthalmitis incidence between instrument types was noted, with an incidence of 1/5498 cases among PPVs performed with 20-gauge instruments, and 1/434 cases among PPVs performed with 25-gauge instruments. Potential explanations for the higher rate with smaller-gauge instruments include wound formation problems, lack of wound closure, early postoperative hypotony, or differences in fluid flow rate. Dr Kunimoto proposed that wound closure could be improved by displacing the conjunctiva, beveling the sclerotomy wound, and inspecting for fluid leakage. None of the patients who developed endophthalmitis had had a beveled sclerotomy. This is the first report of endophthalmitis incidence for 25-gauge PPV.
Dr Avery reiterated the importance of a beveled incision in PPV. Dr Lim wondered whether antibiotic infusions would improve outcomes. In response to another panelist’s question, Dr Kunimoto stated that there was no documented hypotony in the eyes with endophthalmitis. |
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