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Published on: October 20, 2019
Conjunctival epithelium in pars plana vitrectomy specimens
Thomas A Albini1, Monica Evans, Rohit R Lakhanpal
1Doheny Retina Institute, Los Angeles, CA 90033, USA.
Purpose:
To review histopathology of vitrectomy specimens obtained during routine pars plana vitrectomy (PPV) for evidence of inadvertent introduction of conjunctival epithelium into the vitreous cavity during PPV.
Methods:
Retrospective review of all vitreous specimens obtained from PPV over a 3-year period during which vitreous samples were routinely submitted from routine and diagnostic PPV. Patient charts and operative reports were reviewed, with particular attention to history of postoperative endophthalmitis, and the use of transconjunctival PPV.
Results:
A total of 650 specimens were obtained over a 3-year period. Three specimens with conjunctival epithelium were identified. None of these cases resulted in endophthalmitis. Two of these three cases used transconjunctival techniques. In one case all three sclerotomies were made using transconjunctival techniques.
Conclusions:
The presence of conjunctiva in the vitreous aspirate from completely transconjunctival PPV indicates that conjunctival epithelium can be inadvertently introduced into the vitreous cavity during PPV. Although none of these cases resulted in endophthalmitis, special care to sterilize the conjunctiva before the creation of transconjunctival sclerotomies is warranted.
Insights
Conjunctival epithelium can enter the vitreous during pars plana vitrectomy (PPV), especially with transconjunctival techniques. Careful conjunctival sterilization is recommended to prevent this, though endophthalmitis was not observed in this study.
Area of Science:
- Ophthalmology
- Surgical Pathology
Background:
- Pars plana vitrectomy (PPV) is a common surgical procedure for various vitreoretinal diseases.
- Transconjunctival PPV techniques aim to minimize ocular surface disruption.
- Histopathological analysis of intraoperative specimens can reveal surgical complications.
Observation:
- A retrospective review of 650 vitrectomy specimens was conducted.
- Three specimens (0.46%) demonstrated the presence of conjunctival epithelium.
- Two of these cases involved transconjunctival sclerotomy creation.
Findings:
- Conjunctival epithelium was inadvertently introduced into the vitreous cavity in a small percentage of PPV cases.
- The presence of conjunctival epithelium did not correlate with postoperative endophthalmitis in this series.
- Complete transconjunctival PPV techniques showed a higher incidence of epithelial introduction.
Implications:
- Enhanced conjunctival preparation is crucial before creating transconjunctival sclerotomies during PPV.
- Vigilance for potential epithelial contamination is necessary even in routine PPV procedures.
- Further research may explore standardized protocols for conjunctival antisepsis in transconjunctival surgery.
