April 2014
Volume 55, Issue 13
ARVO Annual Meeting Abstract  |   April 2014
Title: Microbiologic Analysis in 23-ga office-based sutureless pars plana vitrectomy
Author Affiliations & Notes
  • Cynthia Qian
    Ophthalmology, Retina Service, Massachusetts Eye and Ear Infirmary, Boston, MA
  • Flavio Rezende
    Ophthalmology, University of Montreal, Montreal, QC, Canada
  • Przemyslaw Sapieha
    Ophthalmology, University of Montreal, Montreal, QC, Canada
  • Footnotes
    Commercial Relationships Cynthia Qian, None; Flavio Rezende, None; Przemyslaw Sapieha, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 2326. doi:
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      Cynthia Qian, Flavio Rezende, Przemyslaw Sapieha; Title: Microbiologic Analysis in 23-ga office-based sutureless pars plana vitrectomy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2326.

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

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Purpose: To perform a microbiological contamination analysis of the vitreous during office-based micro-incisional vitrectomy surgery assessing whether the bacteria detected correlated with patient’s ocular conjunctival flora.

Methods: Participants were patients undergoing office-based MIVS, anti-VEGF, and dexamethasone intravitreal injections (triple therapy) for the treatment of wet age-related macular degeneration (AMD) and diabetic macular edema (DME). All patients were operated at a small procedure room in an ambulatory clinic of the Department of Ophthalmology, University of Montreal, Quebec, Canada. Conjunctival samples were done before placing the sclerotomies. The MIVS was done with a 23-gauge retractable vitrector, a 27-gauge infusion line, and a 29-gauge chandelier. Undiluted and diluted vitreous were collected for aerobic, anaerobic and fungal cultures.

Results: Thirty-seven patients (37 eyes) were recruited and completed over 17 months of follow-up. Twenty-eight had wet AMD and 9 had DME. There were 13 men and 24 women, with a mean age of 78 years. 18 patients (46%) had culture positive conjunctival flora. 26 bacterial colonies were tabulated in total from the conjunctival swabs. All bacteria detected were gram-positive bacteria (100%), most commonly: Staphylococcus epidermitis in 11 (42%) and Corynebacterium colonies in 6 (23%). Only 1/18 patients had more than 3 species isolated, 6/18 patients had 2 species and 11/18 patients had 1 species identified on the conjunctival swab. Only 1 of the 37 undiluted midvitreous samples was culture positive, equating to a contamination rate of 2.7%. None of the diluted vitreous samples were culture positive. All cultures were negative for fungus. No serious postoperative complications occurred, including bacterial endophthalmitis, choroidal detachment, and retinal detachment.

Conclusions: This preliminary study of office-based MIVS gives us insights on the ocular surface microbial profile and vitreous contamination rate of performing such procedures outside the OR-controlled environment. Our initial results seem to indicate that there is little risk of bacterial translocation and contamination from the conjunctiva into the vitreous. Therefore, if endophthalmitis occurs post-operatively, the source may likely arise after the procedure. Larger studies are needed to confirm our data.

Keywords: 688 retina • 762 vitreoretinal surgery • 593 microbial pathogenesis: clinical studies  

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