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Glaucoma is an eye condition characterized by increased intraocular pressure that damages the retina and optic nerve, leading to irreversible blindness if left untreated. The human eye has various components, including the cornea, iris, pupil, lens, and optic nerve. Aqueous humor is secreted by the epithelium of the ciliary body in the posterior chamber and flows through the trabecular meshwork and canal of Schlemm, maintaining normal intraocular pressure. The trabecular meshwork and the canal...
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ENDOPHTHALMITIS INCIDENCE AFTER VITRECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RISK FACTORS AND PREVENTION

Robert McGrath1, Liam Mulcahy, Abdulrahman Al Abri

  • 1Mater Misericordiae University Hospital, Dublin, Ireland.

Retina (Philadelphia, Pa.)
|February 18, 2026
PubMed
Summary

Endophthalmitis risk after vitrectomy is 0.14%. Non-fluid tamponade significantly reduced risk, while subconjunctival antibiotics did not. Small-gauge vitrectomy and phaco-vitrectomy showed no increased risk.

Keywords:
Vitrectomy Retinal surgery Endophthalmitis Meta-analysis Systematic review

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Area of Science:

  • Ophthalmology
  • Surgical Innovation
  • Infectious Disease Prevention

Background:

  • Endophthalmitis is a serious complication following vitrectomy surgery.
  • Optimal strategies to minimize endophthalmitis rates remain debated.
  • Current literature lacks consensus on best practices for risk reduction.

Purpose of the Study:

  • To determine the incidence of post-vitrectomy endophthalmitis.
  • To evaluate the effectiveness of various risk-reduction strategies.
  • To identify factors associated with increased or decreased endophthalmitis risk.

Main Methods:

  • Comprehensive literature search for endophthalmitis incidence post-vitrectomy.
  • Meta-analysis of 69 studies involving 1,979,160 vitrectomies.
  • Comparison of risk factors: instrument gauge, prophylactic antibiotics, phaco-vitrectomy, intraocular tamponade.

Main Results:

  • Identified 2,781 cases of endophthalmitis (0.14% incidence).
  • Smaller-gauge vitrectomy (25-gauge) showed significantly higher endophthalmitis rates than 23-gauge.
  • Non-fluid intraocular tamponade significantly reduced endophthalmitis risk (OR 0.15).
  • Subconjunctival antibiotics did not reduce risk compared to topical (OR 0.77).
  • Phaco-vitrectomy did not increase endophthalmitis risk (OR 1.17).

Conclusions:

  • Endophthalmitis incidence post-vitrectomy is 0.14%.
  • Non-fluid intraocular tamponade is a key strategy for reducing endophthalmitis.
  • Subconjunctival antibiotics offer no significant benefit over topical application.
  • Small-gauge vitrectomy and phaco-vitrectomy are not associated with significantly higher endophthalmitis rates.