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Thomas Lindquist, Lauren Mason, John Mason, John Mason, Gerald McGwin, Carrie Huisingh, Duncan Friedman, Robert Morris, Matthew Oltmanns, Amanda Dinsmore; Postoperative bacterial endophthalmitis: tap/inject versus sutureless vitrectomy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3173.
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© ARVO (1962-2015); The Authors (2016-present)
To compare sutureless vitrectomy (VIT) versus vitreous tap with injection (TAP) in eyes presenting with postoperative bacterial endophthalmitis.
Retrospective cohort study of 126 consecutive eyes with postoperative bacterial endophthalmitis that underwent initial VIT (n=82) or TAP (n=44) between 2005 and 2011 at the UAB Callahan Eye Foundation Hospital. All eyes were stratified into a group according to their pre and postoperative visual acuity (group 1= 20/40 or better, group 2= 20/50-20/100, group 3 = <20/100-20/400, group 4 = <20/400-CF, group 5 = HM-LP) for statistical analysis. Outcome measures were post-intervention vision and complications.
Mean preoperative vision was 20/2000 in VIT group and 20/1800 in TAP (p=0.30). Mean postoperative vision was 20/160 in VIT and 20/125 in TAP (p=0.18). Cultures were positive in 75/126 (60%) eyes, and 8 organisms were identified. The most common organisms were coagulase-negative Staphylococcus 46/126 (37%), Streptococcus sp. 14/126 (11%), and Enterococcus sp. 6/126 (4.7%). Preoperative vision was HM or LP in 87/126 eyes. Among those with poor preoperative vision of <20/400, postoperative vision was significantly better in the VIT group when compared to the TAP group (p=0.05). In eyes with good preoperative vision (20/400 or better), the mean postoperative vision was not significantly different between the VIT or TAP group (p=0.94). Final vision in all eyes was 20/40 or better in 25%. In 56%, vision was 20/100 or better; only 11% had vision of HM or worse. Risk factors for poor outcome (<20/400) included infection with Enterococcus (p=0.01). Preoperative vision and IOP (<5 or >26) showed a trend toward poor outcome (p=0.09 and 0.08 respectively). Twelve eyes (9.5%) developed retinal detachment (RD), all in the VIT group, with 11/12 presenting with poor preoperative vision.
In the largest series to date since the Endophthalmitis Vitrectomy Study, VIT or TAP appears to have similar visual outcome in patients with postoperative bacterial endophthalmitis that present with 20/400 or better vision. Sutureless vitrectomy was found to be more beneficial than TAP in patients with worse than 20/400 initial vision. The majority of patients have a final vision of 20/100 or better. RD is more likely in the VIT group primarily due to poor presenting visual acuity.
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