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Kapil G. Kapoor, Gibran S. Khurshid; Silicone Oil As An Adjunct In The Surgical Management Of Endophthalmitis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2619.
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Silicone oil is a retinal tamponade agent that can improve intraocular oxygen tension and has strong antimicrobial activity, making it an attractive adjunct for endophthalmitis. Despite significant advancement in vitreoretinal surgical techniques and equipment over the last sixteen years, the Endophthalmitis Vitrectomy Study (EVS) establishes the current standard of care for endophthalmitis, indicating surgical intervention only if vision deteriorates to light perception. The purpose of this study is to evaluate the efficacy of early vitrectomy with adjunctive silicone oil to treat endophthalmitis.
An interventional consecutive retrospective study was completed of thirty eyes of thirty patients with endophthalmitis from a university-based practice. Surgical management included early 20 gauge vitrectomy/vitreous biopsy, and 1000 centistoke silicone oil tamponade. Patients in group 1 (n=14) underwent 1000 centistoke silicone oil tamponade for 12 weeks, and patients in group 2 (n=16) underwent 1000 centistoke silicone oil tamponade for 24 weeks. Outcome measures included best corrected visual acuity, need for additional surgery, and major adverse events, which were defined as persistent intraocular pressure >30 mm Hg, retinal detachment, phthisis, or progression to enucleation. Fisher’s exact T-Test was used for statistical analysis.
All thirty patients completed at least 9 months’ followup. There was no statistically significant difference between group 1 and group 2 patients regarding BCVA, need for additional surgery, or major adverse events. At 9 months', 73% of all patients (22/30) achieved best corrected visual acuity (BCVA) of 20/40 or better. When compared with EVS (53%), this difference was statistically significant (p <.01). 97% of patients achieved BCVA of 20/100 or better in the study group, compared to 74% in EVS (p <.01). 3% of patients had major adverse effects in our study at 9 months’ followup, compared to 9% in EVS. Additional surgery was required in 3% (1/30) in the study group, compared to 35% requiring additional surgery in EVS (p<.01).
In this study, 12 and 24 week silicone oil tamponade demonstrated equivalent efficacy and adverse event profile in the management of endophthalmitis. This investigation highlights the efficacy of silicone oil as an adjunct to early vitrectomy in the surgical management of endophthalmitis. This data suggests that early vitrectomy with silicone oil tamponade may improve outcomes compared to the current standard of care, even in eyes with vision better than light perception.
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