Abstract
Purpose :
Retinal detachment is a known complication after pars plana vitrectomy (PPV) for endophthalmitis. However, existing studies do not stratify these events by type/mechanism. This retrospective series describes intraoperative pathologic findings among eyes which required repeat PPV after initial small-gauge vitrectomy for endophthalmitis.
Methods :
Demographic and clinical data was collected for 108 surgically treated endophthalmitis cases. Patients who underwent initial small-gauge PPV for endophthalmitis (either primarily or after failing to improve with intravitreal antibiotic injections) from 2013-2022 were included. Cases requiring repeat PPV were identified, with Kaplan-Meier analysis used to calculate the cumulative incidence. Clinical and microbiologic predictors for specific intraoperative findings (tractional retinal detachment, TRD; rhegmatogenous retinal detachment, RRD; epiretinal membrane, ERM) were identified with one-way ANOVA and cross-tabulation analysis.
Results :
Fifty-five eyes (mean follow up 15.0 ± 22.2 months) were included. Seventeen eyes underwent repeat PPV, with a 43.8% (CI-95; 31.0-56.6%) cumulative incidence at 14 months (Fig 1). TRD were present in 47.1% of repeat PPV cases, comprising 66.7% of all post-PPV retinal detachments (Fig 2). RRD and ERM were each found in 23.5% of repeat PPV (7.3% of included eyes). Diabetes mellitus (p = 0.022) and Staphylococcus epidermidis infection (p = 0.003) were associated with post-PPV TRD and ERM, respectively, among patients with endophthalmitis.
Conclusions :
A significant percentage of patients treated surgically for endophthalmitis require repeat PPV. The 2:1 ratio of TRD to RRD in this series suggests a tradeoff between decreased retinal breaks and increased inflammatory debris retention during initial small-gauge vitrectomy (particularly with 25-gauge instrumentation). Surgeons should plan for possible TRD repair when considering reoperation in patients with endophthalmitis.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.