September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Early Micro-incisional Pars Plana Vitrectomy for the treatment of Acute Infective Endophthalmitis: The Sydney Eye Hospital Experience
Author Affiliations & Notes
  • Guillermo Fernandez-Sanz
    Fundacion Jimenez Diaz University Hospital, Madrid, Spain
    Retina Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia
  • Steve Levasseur
    Retina Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia
  • Eugene Ting
    Retina Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia
  • Gerald Liew
    Retina Associates, Sydney, New South Wales, Australia
    Westmead Hospital, Sydney, New South Wales, Australia
  • Justin Playfair
    Retina Associates, Sydney, New South Wales, Australia
    Retina Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia
  • John Downie
    Retina Consultants, Sydney, New South Wales, Australia
    Retina Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia
  • Mark Gorbatov
    Retina Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia
  • Alex Paul Hunyor
    Retina Associates, Sydney, New South Wales, Australia
    Retina Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia
  • Andrew Alexander Chang
    Sydney Retina Clinic and Day Surgery, Sydney, New South Wales, Australia
    Retina Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia
  • I-Van Ho
    Retina Associates, Sydney, New South Wales, Australia
    Retina Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia
  • Footnotes
    Commercial Relationships   Guillermo Fernandez-Sanz, None; Steve Levasseur, None; Eugene Ting, None; Gerald Liew, None; Justin Playfair, None; John Downie, None; Mark Gorbatov, None; Alex Hunyor, None; Andrew Chang, None; I-Van Ho, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 4459. doi:
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      Guillermo Fernandez-Sanz, Steve Levasseur, Eugene Ting, Gerald Liew, Justin Playfair, John Downie, Mark Gorbatov, Alex Paul Hunyor, Andrew Alexander Chang, I-Van Ho; Early Micro-incisional Pars Plana Vitrectomy for the treatment of Acute Infective Endophthalmitis: The Sydney Eye Hospital Experience. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4459.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Acute-onset infectious endophthalmitis (IE) remains one of the most devastating complications and challenges faced in ophthalmology. Lately, there has been a trend towards early vitrectomy for the management of acute endophthalmitis.
We performed a retrospective, interventional clinical study to evaluate the efficacy and safety of early micro-incisional pars plana vitrectomy (PPV) for the treatment of patients with acute-onset infective endophthalmitis.

Methods : Retrospective chart review of all consecutive patients who presented with suspected acute infective endophthalmitis and underwent early PPV between 2009 and 2013 at Sydney Eye Hospital.

Results : 64 patients met the inclusion criteria. Median age was 77.5 years (range 43-92, ±11.4). The inciting event was phacoemulsification and intraocular lens implant in 34 patients (53%), intravitreal injections in 23 (36%), trabeculectomy in 2 (3%), endogenous in 2 (3%) and the remaining 3 followed vitrectomy, lens exchange and globe rupture. The visual acuity improved from mean baseline logMAR 3.1 to 1.02 at 1 year, with 42% achieving final VA equal to or better than logMAR 0.477. Final visual acuity in culture negative patients was logMAR 0.65 while the VA in culture positive cases was logMAR 1.22 (p value 0.01). Endophthalmitis post cataract surgery had a final VA of logMAR 0.65 while VA post intravitreal injection was logMAR 1.42 (p. value 0.002). Intraoperative retinal detachment (RD) was found in 6 patients (9.4%) and 4 patients (6.2%) had an RD postoperatively. Evisceration was required in 2 patients (3%), epiretinal membrane was found in 6 patients (9.4%), postoperative hypotony in 1 patient (1.6%) and ocular hypertension in 4 patients (6.2%).

Conclusions : Patients with acute infective endophthalmitis undergoing early PPV experience VA improvement in the majority of cases. Negative cultures and endophthalmitis post cataract surgery were factors that led to better final visual outcome. The rate of intraoperative and posteroperative RD is of concern and needs to be further assessed.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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