The Incidence of Endophthalmitis following 23-gauge versus 20-gauge Pars Plana Vitrectomy

Abstract

Purpose: : To compare (1) the incidence of endophthalmitis following transconjunctival sutureless 23-gauge versus conventional 20-gauge pars plana vitrectomy (PPV) and (2) to investigate clinical features including visual acuity outcomes of endophthalmitis following PPV.

Methods: : We retrospectively reviewed the medical records of 8,806 consecutive cases of PPV in one academic center between January 1, 2007 and September 30, 2010. We compared the endophthalmitis rate following transconjunctival sutureless 23-gauge PPV and conventional 20-gauge PPV. We also evaluated the rate of suturing for significant leakage at the sclerotomy site at the end of the surgery in the 23-gauge group, and the clinical course and final visual outcomes of cases of endophthalmitis in both groups.

Results: : There were 2,515 and 6,291 cases in the 23-gauge and the conventional 20-gauge group, respectively. In 16 of 2,515 eyes in the 23-gauge group (0.6%), suturing of the sclerotomies were needed due to persistent significant leaking at the end of the surgery. Endophthalmitis developed in 1 of 2,515 cases following 23-gauge PPV (0.04%) and in 3 of 6,291 cases following 20-gauge PPV (0.05%). Mean time between PPV and endophthalmitis was 3.5 days (range: 2-7 days). Presenting visual acuity was finger count in 1 eye and hand motion in 3 eyes. Initial treatment included intravitreal injection of antibiotics in 2 eyes and vitreous irrigation and injection of antibiotics in 2 eyes. Culture results were negative in 2 eyes and no culture specimens were obtained in 2 eyes. Inflammation was controlled within 8 days in the all cases. Mean final visual acuity was 20/63 (range: 20/30-20/160)

Conclusions: : The incidence of endophthalmitis following 23-gauge PPV was not higher than that of 20-gauge PPV in spite of the low suturing rate of sclerotomy site in 23-gauge group. Endophthalmitis following PPV occurred within 7 days of the previous PPV and had relatively good visual acuity outcome following management with intravitreal antibiotics.

Keywords: endophthalmitis • vitreoretinal surgery