The microsurgical safety task force: guidelines for minimizing endophthalmitis with vitrectomy surgery

The transition from 20-gauge vitrectomy surgery to 23-gauge and 25-gauge instrumentation was not without its complications. Early instrumentation provided limitations in surgical technique, including limited illumination, instrument flex, and efficiency of vitreous removal. The most concerning finding arose from two separate retrospective studies which reported increased rates of postoperative endophthalmitis following small-gauge vitrectomy. This situation raised questions as to whether this shift in technique was appropriate.

Following these concerning reports of complication, a Microsurgery Safety Task Force was convened to evaluate the scientific evidence and create guidelines with the intent to minimize the rates of postoperative infection with small-gauge vitrectomy surgery. Further studies of wound architecture and advances in instrumentation and surgical technique have improved outcomes. More recent studies demonstrate equivalent rates of postoperative endophthalmitis between 20-gauge and smaller gauge instrumentation.

The guidelines of the Microsurgery Safety Task Force, evolutions in instrumentation and surgical technique, and improved understanding of small-gauge vitrectomy wound construction have yielded comparable results in endophthalmitis rates for small-gauge vitrectomy versus traditional 20-gauge approaches.