Abstract
Purpose :
Prophylactic topical eye drops to be instilled by the patient after undergoing vitreoretinal surgery can be inconvenient and expensive. We performed a retrospective clinical study to evaluate the outcomes of a novel, modified-dropless protocol for 25-gauge and 27-gauge (27G) micro-incision vitrectomy surgery (MIVS) that omits any intraocular injections of antibiotics or steroids.
Methods :
The Institutional Review Board approved a database review of all patients with any surgical indication for MIVS that underwent the modified-dropless protocol performed by a single surgeon at Oregon Eye Consultants, LLC. Eighty-nine patients who had surgery between February to November 2020 were eligible from 108 total surgeries. Only patients who underwent a surgical peritomy were not candidates for the modified-dropless protocol. Instead of pre- or post-operative drops, at the time of surgery patients were given a 0.5cc subconjunctival injection of a 1:1 Cefazolin (50mg/cc):Dexamethasone (10mg/cc) in the inferior fornix and 0.5cc of posterior Sub-Tenon’s Kenalog (STK). No intravitreal injections were administered. Fourteen patients who had a penicillin allergy were instead given separate subconjunctival injections of 0.25cc each of Vancomycin (10mg/cc) and Dexamethasone. Mean follow up was 69 days.
The primary endpoint was postoperative cases of endophthalmitis within 3 months. Secondary endpoints consisted of Best-Corrected Distance Visual Acuity (BCVA), intraocular pressure (IOP), and postoperative complications (retinal detachments, inflammation, need for additional surgery) within 3 months of surgery.
Results :
The study comprised 89 eyes from 46 females and 43 males (mean age 69.9±9.7; range 37-93 years). Pre-operatively there were 41 phakic and 48 pseudophakic eyes. All surgeries were performed with the 27G MIVS platform.
There were no cases of postoperative endophthalmitis. Mean logMAR BCVA improved from 0.65±0.64 to 0.54±0.58 postoperatively (p=0.03). Excluding patients who had silicone oil tamponade, postoperative BCVA improved from 0.58±0.60 to 0.46±0.50 (p=0.01). Mean IOP increased from 14.3±3.7 to 15.1±4.1 postoperatively (p=0.12).
Conclusions :
A modified-dropless postoperative protocol involving subconjunctival and posterior sub-Tenon’s injections only may be a safe and convenient alternative to topical eye drops for patients undergoing MIVS but additional and larger studies are needed.
This is a 2021 ARVO Annual Meeting abstract.