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Shaival S. Shah, Ryan M. Tarantola, Jordan M. Graff, James C. Folk, H C. Boldt, Karen M. Gehrs, Stephen R. Russell, Vinit B. Mahajan; Diagnostic Vitreous Biopsy with Small-gauge Vitrectomy Instrumentation. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5603.
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To review outcomes of diagnostic vitreous biopsy performed with small-gauge vitrectomy instrumentation in cases of endophthalmitis.
Retrospective case series. Cases of endophthalmitis with presumed infectious etiology that underwent diagnostic vitrectomy with either 23-gauge or 25-guage instrumentation were assembled from a 4-year period. Demographic data, preoperative, intraoperative, and postoperative exam records were reviewed. The culture-positive rate, causative organism, and visual outcome were collected.
Thirty infectious endophthalmitis cases managed with small-gauge vitrectomy were identified. The indication for vitrectomy included post-cataract endophthalmitis (7/30), bleb-related endophthalmitis (7/30), post-steroid implant/injection endophthalmitis (5/30), endogenous endophthalmitis (4/30), post-intravitreal injection endophthalmitis (4/30), post-keratoplasty endophthalmitis (2/30) and seton tube exposure endophthalmitis (1/30). Biopsies were culture positive in 12/30 cases. The most frequent organisms were coagulase-negative Staphlococci. Other organisms included Staphylococcus Aureus, Streptococcus species, Fusarium, Candida Albicans, Aspergillus. Average follow-up was 6.8 months (range 1 month to 2 years). Preoperative visual acuity ranged from 20/80 to light perception. Final postoperative visual acuity ranged from 20/20 to LP with the best outcomes in post-cataract cases and the worst in bleb-related and endogenous endophthalmitis cases. Additional surgery was required in 4 cases.
Although small-gauge vitrectomy instrumentation may provide some technical advantages, visual outcome remains dependent on clinical setting and infectious agent. Further studies are needed to determine whether positive culture rates are comparable to those achieved with 20-guage instrumentation. Interestingly, intravitreal injections are emerging as a common indication for diagnostic vitrectomy.
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