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Jonathan C Park, Balasubramanian Ramasamy, Stephen Shaw, Som Prasad, Roland Ling; A Prospective And Nationwide Study Investigating Endophthalmitis Following Pars Plana Vitrectomy: Incidence, Risk Factors, Clinical Presentation, Microbiology, Management and Outcome. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3853.
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This is the first nationwide prospective study to investigate the incidence and risk factors of endophthalmitis following pars plans vitrectomy. The study also aims to provide epidemiological data relating to clinical presentation, microbiology, management and outcome of endophthalmitis following vitrectomy.
This was a prospective, nationwide (United Kingdom) case-control study. Cases of presumed infectious endophthalmitis within 6 weeks of pars plans vitrectomy were reported via the established British Ophthalmological Surveillance Unit (BOSU). The surveillance period was two years. Controls (patients who had vitrectomy but no endophthalmitis) were recruited from 9 randomly selected UK centers.
Thirty-seven reports were received and 28 cases met the diagnostic criteria for presumed infectious endophthalmitis following vitrectomy.The incidence of endophthalmitis following vitrectomy was 28 cases per 48,433 vitrectomies (1 in 1,730 with a 95% CI of 1 in 1,263 to 1 in 2,747). Two hundred and seventy two controls were randomly recruited from 9 UK centers. Smaller gauge port sizes were not found to be a risk. Immunosuppression (OR 19.0, p = 0.001) and pre-operative topical steroids (OR 131.4, p < 0.001) increased the endophthalmitis risk. Operating for retinal detachment was associated with a reduced risk of endophthalmitis (OR 0.10, p = 0.005). Mean age was 61 years and 67% were male. Nineteen cases were 23/25 gauge and 9 cases were 20 gauge. Mean time from surgery to endophthalmitis was 5 days. Blurred vision (85.2%), pain (77.8%) and a hypopyon (77.8%) were the commonest presenting symptoms and signs. Seventeen cases (60.7%) had a positive culture. Culture positive endophthalmitis, relative to culture negative endophthalmitis, was no different with respect to time to presentation, symptoms, signs or outcome. Outcome was poor with 29.6% of eyes being eviscerated or having no perception of light or perception of light.
Endophthalmitis following vitrectomy is rare. Operating with smaller gauge port sizes does not increase the risk of endophthalmitis.This study helps surgeons promptly identify cases of endophthalmitis following vitrectomy, and informs them about the various management options currently used and the likely outcome of this devastating complication.
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