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Clinical Factors and Outcomes of Acute-Onset Endophthalmitis Following Small-Gauge Pars Plana Vitrectomy Surgery

Tommaso Vagaggini, Olufemi E Adams, Christian D Curran

    Ophthalmic Surgery, Lasers & Imaging Retina
    |July 7, 2023
    PubMed
    Abstract

    Insights

    Acute endophthalmitis (AE) after small-gauge pars plana vitrectomy (PPV) outcomes were similar regardless of urgent PPV. Tamponade and sclerotomy suturing may influence AE risk following PPV.

    Area of Science:

    • Ophthalmology
    • Retinal Surgery
    • Infectious Disease

    Background:

    • Acute endophthalmitis (AE) is a rare but serious complication following small-gauge pars plana vitrectomy (PPV).
    • Understanding risk factors and outcomes is crucial for managing this sight-threatening condition.
    • Previous studies have explored AE post-PPV, but specific factors related to small-gauge surgery require further investigation.

    Purpose of the Study:

    • To describe the risk factors, clinical findings, and visual outcomes of acute endophthalmitis (AE) occurring after small-gauge pars plana vitrectomy (PPV).
    • To compare outcomes between patients who underwent urgent PPV and those who received other treatments for AE.
    • To identify potential surgical or management factors associated with AE post-PPV.

    Main Methods:

    • Retrospective, single-center, nonrandomized study of patients diagnosed with AE from 2013 to 2021.
    • All patients underwent vitreous biopsy prior to treatment.
    • Patients were categorized into two groups: urgent PPV (within 3 days of diagnosis) and other treatments (non-urgent). The primary outcome was best-corrected visual acuity (BCVA) at 6 months.

    Main Results:

    • Twenty-one patients were analyzed; epiretinal membrane was the most common indication for PPV (48%).
    • The overall incidence of AE post-PPV was 0.074%, with a 57% culture-positive rate.
    • No significant difference in final BCVA at 6 months was observed between the urgent PPV group (median 0.40 logMAR) and the other treatment group (median 0.35 logMAR).
    • Sclerotomy wounds were not sutured in 71% of cases, and 24% or 38% received no or partial tamponade, respectively.

    Conclusions:

    • Urgent surgical intervention (PPV) did not significantly impact visual outcomes compared to other treatments for acute endophthalmitis post-PPV.
    • Factors such as tamponade agents and the use of sclerotomy suturing may play a role in the occurrence of AE following small-gauge PPV.
    • Further research is warranted to elucidate the precise impact of these surgical variables on AE development and management.

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