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Sina Vahedi, Murtaza K Adam, Michael Dollin, Joseph Maguire; Utilization of a 25-Gauge Trocar for Vitreous Tap and Injection in Eyes with Endophthalmitis. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4189.
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The standard treatment of endophthalmitis involves multiple needle injections through the pars plana for vitreous sampling and delivery of intravitreal antibiotics and steroid. A technique utilizing a single 25-gauge vitrectomy trocar was recently described, requiring only a single penetration. We evaluated physician ease of use and patient comfort with both techniques in patients with acute endophthalmitis following cataract surgery, secondary intraocular lens implantation, or intravitreal injection of an anti-vascular endothelial growth factor agent.
A prospective, cross-sectional, case-control study of patients with acute endophthalmitis was performed. Patients were randomized to undergo standard tap and injection or using a single 25-gauge trocar (Alcon Inc., Fort Worth, TX). The anesthetic protocol was standardized and patients masked to the treatment method utilized. Main outcome measures were ease of use, as measured by the treating physician using a standardized comparative ease-of-use rating scale, and patient comfort, as measured by the patient using a standardized pain scale. Secondary outcome measures included percentage of patients in which a vitreous sample was successfully obtained, vitreous sample volume, and percentage of culture positive vitreous samples.
Eighteen patients with endophthalmitis were enrolled with nine patients randomized to each treatment group. There were no adverse events. There was no significant difference between physician ease of use scores (p=0.796, Mann-Whitney U) and patient pain scale scores (p=0.340, Mann-Whitney U) between groups. In the standard group, 56% of patients underwent successful vitreous tap, an average of 0.2 mL of vitreous sample was obtained, and 60% of samples were culture positive. In the trocar group, 78% of patients underwent successful vitreous tap, an average of 0.24 mL of vitreous sample was obtained, and 71% of samples were culture positive.
Comparing standard tap and injection to a single 25-gauge trocar for endophthalmitis treatment, there were no differences in physician ease of use and patient pain scale scores. The trocar technique provides a safe and equally effective alternative for delivery of intravitreal antibiotics and steroids, as well as procuring a vitreous sample, requiring one sharp penetration.
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