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Fiore Tito, Marco Lupidi, Carlo Cagini, Elisa Spaccini, Alessio Cerquaglia, Gabriel J Coscas; Small gauge pars plana vitrectomy for endophthalmitis after cataract surgery: clinical and OCT findings.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5498.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate retinal and foveal microvasculature changes in patients treated with 25 gauge pars plana vitrectomy (PPV) for severe postcataract bacterial endophthalmitis.
A retrospective, nonrandomized, interventional case series of patients with acute and chronic postcataract bacterial endophthalmitis was performed. Diagnostic and therapeutic 25 gauge vitrectomy was performed in all eyes. Preoperative and postoperative best-corrected visual acuity (BCVA) in the study eye was performed. Spectral domain optical coherence tomography (SD-OCT) images were acquired (Spectralis HRAII + OCT, Heidelberg Engineering, Heidelberg, Germany) to study macular thickness of both eyes for each patient. Moreover a fully automated quantitative analysis of the foveal avascular zone (FAZ), and of the total vascular and avascular surfaces (in a 1-mm-radius area) was performed using a Spesctralis OCT-A (Heidelberg Engineering, Heidelberg, Germany). The measurements obtained in the operated eye were compared to the fellow eye by Wilcoxon matched pair test.
Thirteen patients (6 men, 7 women) were included in the study. Postoperative BCVA was ≥ 20/40 in 12 eyes, ≥ 20/25 in 10 eyes, while the only eye with postoperative BCVA of 20/200 had atrophic age-related macular degeneration (AMD). Mean postoperative macular thickness was 326,18 ± 27,83 µm in the study eyes compared to 318,02 ± 27,90 µm in the fellow eyes. In the superficial capillary plexus (SCP), mean postoperative FAZ surface, total vascular and avascular surfaces were 236148 µm, 764011 µm, 2141405 µm in the study eyes compared to 269394 µm, 663144 µm, 2209051 µm, in the fellow eyes. In the deep capillary plexus (DCP), mean postoperative FAZ surface, total vascular and avascular surfaces were 253950 µm, 726175 µm, 2141405 µm in the study eyes compared to 281039 µm, 646394 µm, 2214200 µm, in the fellow eyes. No differences were noted between staudy eyes and healthy eyes (p = n.s).
The absence of significant structural and foveal microvasculature changes on OCT and the high postoperative BCVA seem to support the idea that 25 gauge PPV may represent a successful treatment for the management of postoperative endophthalmitis following cataract surgery and may guarantee good clinical results even in long term after this severe postcataract complication.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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