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Abdhish R Bhavsar; Eliminating Topical Antibiotics after Vitrectomy Surgery. Invest. Ophthalmol. Vis. Sci. 2020;61(7):4405.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the rate of endophthalmitis after vitrectomy surgery performed by a single surgeon over a period of 22 years in a consecutive series of cases in the absence of topical antibiotics in the days following vitrectomy surgery.
The medical records and practice management database of a single surgeon was searched for all primary vitrectomy surgery codes (67036, 67038, 67039, 67040, 67041, 67042, 67108, 67113) for consecutive cases between June of 1997 and June 2019. The database was then searched for all endophthalmitis codes. These lists were combined. The number of vitrectomy surgeries that were performed for endophthalmitis as the diagnosis for the first surgery were eliminated since these were cases presenting with endophthalmitis for which vitrectomy surgery was the treatment. The number of endophthalmitis cases that had primary vitrectomy surgery prior to the diagnosis of endophthalmitis was noted. All vitrectomy surgeries were performed with a similar regimen of intraoperative medications and postoperative drops. There were no preoperative antibiotics given. All cases received povidone iodine 5% prior to surgery and then additional povidone iodine 5% on the conjunctival surface immediately prior to the vitrectomy incisions. Intraoperative subconjunctival cefazolin (clindamycin was given if the patient was allergic to cefazolin) and dexamethasone were given as standard injections at the conclusion of vitrectomy surgeries. Topical povidone iodine 5%, atropine 1% and polytrim ointment were placed on the ocular surface at the conclusion of surgery. There were no topical antibiotic medications given in the days after the surgery.
There were 5,033 vitrectomy surgeries performed by the primary author (ARB) from June 1997 through June 2019. One hundred sixty five vitrectomy surgeries were performed for endophthalmitis as the first and primary surgery. These were eliminated from the series as these were cases which presented with endophthalmitis, typically after cataract surgery, and which had vitrectomy surgery as the treatment for endophthalmitis. There were no cases of endophthalmitis for the remainder of the 4,868 vitrectomy surgeries.
Vitrectomy surgery can be performed with a low rate of endophthalmitis with topical povidone iodine prior to and immediately after surgery in the absence of topical antibiotics in the days after vitrectomy surgery.
This is a 2020 ARVO Annual Meeting abstract.
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