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A. Y. Hu, J.-L. Bourges, S. P. Shah, A. Gupta, C. R. Gonzales, S. C. N. Oliver, S. D. Schwartz; Endophthalmitis After Pars Plana Vitrectomy: A 20- and 25-Gauge Comparison. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5203.
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Recent retrospective analyses have suggested that post-operative endophthalmitis may be more frequent with 25- than 20-gauge pars plana vitrectomy (PPV). Since the incidence of post-operative infection may depend on the suturing status of the sclerotomy, and the peri-operative anti-infection protocol, we aimed to compare the incidence rate of endophthalmitis after sutureless 25-gauge versus sutured 20-gauge PPV on a large cohort of patients operated with a single peri-operative anti-infection protocol.
In a retrospective, single-center comparative case series, we analyzed 3597 consecutive PPVs. Patients were divided into two study groups by sclerotomy status at the end of surgery: the 20-gauge group had three sutured 20-gauge sclerotomies, and the 25-gauge group had at least one unsutured 25-gauge sclerotomy. Patients with a pre-existing diagnosis of endophthalmitis and vitrectomies performed for implantation of ganciclovir and fluocinolone devices were excluded. Uniform anti-infection protocol included shampoo to the eyelashes, povidone iodine applied directly to the conjunctiva, lashes, and face, and potential vitreous wick repositioning via subconjunctival antibiotic injected over each sclerotomy at the end of surgery. Post-vitrectomy endophthalmitis was defined by clinical criteria independent of microbiological results. Only patients with at least 1 week of followup were included. We compared the incidence of endophthalmitis between the two groups.
1424 25-gauge PPVs and 1948 20-gauge PPVs met inclusion and exclusion criteria. Average (± standard deviation) age of patients was 58.6 (± 21.0) years. Median (range) post-PPV follow-up time was 12.8 (0.25-74.6) months. Endophthalmitis was observed in one patient (0.069%; 95% CI = 0-0.21%) from the 25-gauge group and none in the 20-gauge group (p=0.42, Fisher exact test, 2-tailed). The use of air/gas endotamponade (p<0.0001), and intravitreal triamcinolone (p<0.001) was more common in 25- versus 20-gauge PPV. Silicone oil was used more frequently in 20- versus 25-gauge PPV (p<0.0001).
The incidence of endophthalmitis was low in both groups. We were unable to show a statistically significant difference in the incidence of endophthalmitis between sutureless 25-gauge and sutured 20-gauge PPV, and conclude that a careful peri-operative anti-infection protocol may reduce 25-gauge PPV endophthalmitis risk to that of 20-gauge PPV.
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