Bacterial endophthalmitis associated with a broken and retained small-gauge vitrectomy cannula

To report a case of bacterial endophthalmitis associated with a retained small-gauge vitrectomy trocar.

Retrospective case report of a 66-year-old woman who underwent 25-gauge vitrectomy surgery for an epiretinal membrane who presented with postoperative bacterial endophthalmitis and hand motions vision 3 weeks later.

Aqueous and vitreous biopsy revealed Corynebacterium species sensitive to vancomycin. The patient was initially treated with intravitreal and subconjunctival injections of vancomycin, ceftazidime, and dexamethasone. Surgical exploration during a subsequent vitrectomy surgery revealed a retained, transscleral 25-gauge cannula beneath a subconjunctival abscess. The cannula was removed, and the patient was treated with vitrectomy, debridement and closure of the transscleral wound, and injection of intravitreal antibiotics. Fifteen months of follow-up revealed no recurrence of infection and improvement of vision to 20/150.

Although rare, retained small-gauge vitrectomy cannulas may lead to vision threatening ocular infection. Care should be taken to inspect both the wound and the removed trocar system to ensure complete removal of this surgical device. Detailed counts of all surgical equipment should be routinely performed at the conclusion of vitrectomy surgery.