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I. U. Scott, H. W. Flynn, Jr., S. Dev, S. Shaikh, R. Mittra, F. Arevalo, A. Kychenthal, N. Acar; Endophthalmitis After Small-Gauge Pars Plana Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):691.
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To investigate clinical settings, management, and visual outcomes of endophthalmitis after small-gauge pars plana vitrectomy (PPV) and to review the in vitro effectiveness of antibiotics used to treat this condition.
Records were reviewed of all patients treated by the authors for clinically diagnosed endophthalmitis after small-gauge PPV.
The study included 11 eyes of 11 patients with a median age of 68 years (range, 31-81 years) and median follow-up of 8 months (range, 2-19 months). Indication for PPV included epiretinal membrane (8 eyes), proliferative diabetic retinopathy (1 eye), optic pit with schisis detachment (1 eye), and central retinal vein occlusion with macular edema (1 eye). The PPV was 25-gauge in all cases. Presenting vision was hand motions or better in all study eyes (range, 20/100-hand motions). Initial treatment included vitreous tap and injection of intravitreal antibiotics in 9 (82%) eyes, and PPV and injection of antibiotics in 2 (18%). All patients received intraocular vancomycin; 10 (91%) received intraocular ceftazidime. Oral fluoroquinolones were used in 3 (27%) patients. Four (36%) patients received additional doses of intravitreal antibiotics. Eight (73%) patients achieved a final vision of 20/400 or better, and four (36%) achieved 20/63 or better (range, 20/25-light perception). Three cases were culture-negative and no cultures were obtained in one case. Six of the 7 isolates were coagulase-negative staphylococci and 1 was a gram-positive coccus (unspecified). All 6 isolates tested for sensitivity to vancomycin were sensitive and both isolates tested for ceftazidime were sensitive. Final vision was not decreased compared to baseline (pre-injection) in 5 (45%) cases; the primary reason for decreased final vision in the remaining 6 cases was cystoid macular edema (1 eye), cataract (1 eye), endophthalmitis (1 eye), epiretinal membrane (1 eye), corneal edema (1 eye), and vitreous hemorrhage (1 eye).
In contrast to published series of endophthalmitis following 20-gauge PPV, endophthalmitis after small-gauge PPV was usually due to coagulase-negative staphylococci and was associated with generally better visual outcomes. Vancomycin for gram-positive coverage and an aminoglycoside or a cephalosporin for gram-negative coverage provide broad-spectrum coverage for bacterial endophthalmitis after PPV.
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