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Modified-dropless protocol (nil intraocular) for micro-incision vitrectomy surgery (MIVS): a retrospective pilot
Noraliz Garcia-O'Farrill1,2, Gordon T Brown3,4, Allan A Hunter3,4
1Oregon Eye Consultants LLC, 3783 International Court, Suite 290, Springfield, OR, 97477, USA. noraliz.garcia@upr.edu.
BMC Ophthalmology
|May 4, 2023
Summary
This study found that a modified dropless protocol using subconjunctival and posterior sub-Tenon's injections is a safe alternative to eye drops for micro-incision vitrectomy surgery (MIVS). No cases of endophthalmitis were observed, demonstrating the efficacy of this approach.
Area of Science:
- Ophthalmology
- Surgical Innovation
- Infection Control
Background:
- Perioperative infection and inflammation prophylaxis in ocular surgery is evolving.
- There is a growing interest in alternatives to standard topical eye drops.
- Micro-incision vitrectomy surgery (MIVS) platforms have advanced.
Purpose of the Study:
- To evaluate the outcomes of a novel, modified-dropless protocol for MIVS.
- To assess the safety and efficacy of omitting intraocular antibiotic or steroid injections.
- To compare outcomes with traditional topical eye drop regimens.
Main Methods:
- Retrospective study of 150 eyes undergoing MIVS (23-G, 25-G, 27-G) from February 2020 to March 2021.
- Modified-dropless protocol: subconjunctival injection of Cefazolin/Dexamethasone and posterior Sub-Tenon's Kenalog (STK).
- Primary safety endpoint: postoperative endophthalmitis; secondary endpoints: Best-Corrected Distance Visual Acuity (BCVA), intraocular pressure (IOP), and complications.
Main Results:
- No cases of postoperative endophthalmitis were reported.
- Mean BCVA improved significantly post-operatively (p=0.02), with greater improvement excluding silicone oil tamponade (p=0.003).
- Mean IOP showed a slight increase (p=0.05); 10 patients required IOP management, 1 had inflammation, and 14 needed further surgery.
Conclusions:
- A modified-dropless protocol using subconjunctival and posterior sub-Tenon's injections is a safe and convenient alternative for MIVS.
- This approach may replace traditional topical eye drops for postoperative care.
- Further larger studies are warranted to confirm these findings.
Keywords:
Dropless MIVSEndophthalmitisInflammation prophylaxisSmall gauge vitrectomySubconjunctival injectionsVitreoretinal surgery
