Endophthalmitis after 25-gauge pars plana vitrectomy

Twenty-five-gauge vitrectomy is a sutureless procedure that allows surgery performed thorough transconjunctival incisions, but the possibility of intraocular infection exists.

We report a case of endophthalmitis after minimally invasive vitrectomy and discuss the possible mechanisms of this complication.

Twenty-five-gauge vitrectomy was performed to treat a patient with proliferative diabetic retinopathy. On the third postoperative day, infectious endophthalmitis was diagnosed, and the patient immediately underwent surgery. After conjunctival dissection, "mushroom-shaped" tissue and purulent discharge were observed at the sclerotomy sites. On the third day after reoperation, visual acuity was no light perception, and the patient underwent evisceration.

We believe that vitreous incarceration after 25-gauge vitrectomy is an additional risk factor for intraocular infection. It is important to exclude vitreous incarceration after removal of the trocar in addition to conjunctival displacement prior to trocar insertion and beveled incision. Instillation of trypan blue stains the extruded vitreous, pointing out the tissue to be removed at the end of the procedure and minimizing the possibility of intraocular infection. Other risk factors include immunossupresion, long duration of the procedure, and multiple instrument entry through the sclerotomy.