23-gauge transconjunctival sutureless vitrectomy in treatment of post-operative endophthalmitis

Graefes Arch Clin Exp Ophthalmol. 2012 Sep;250(9):1367-71. doi: 10.1007/s00417-012-1926-7. Epub 2012 Jan 25.


Purpose: To report the safety and efficacy of 23-gauge (23-G) transconjunctival vitrectomy (TSV) in the surgical management of postoperative endophthalmitis.

Materials and methods: Ten consecutive patients underwent a 23-G TSV in 2008-2010 after cataract surgery (n = 5) or filtrating surgery (n = 5), and were prospectively studied with a minimum follow-up of 6 months. TSV was performed within a median delay of 1 day after the diagnosis, after one or two injections of intravitreal antibiotics (vancomycin, ceftazidime). Conventional cultures (brain heart infusion media) and/or panbacterial PCR were performed on aqueous humor and/or vitreous samples.

Results: Initial visual acuity was less than or equal to hand motion in all cases, and clinical findings included hypopyon (80%), pupillary fibrin membrane (80%), and dense vitreitis (4+, 100%). The bacteria identified were Gram-positive cocci in 60% of the cases (coagulase-negative staphylococci, 20%; streptococcus, 40%) and Gram-negative bacilli in 10% (moraxella lacunata). All patients had central and peripheral vitrectomy (mean duration, 58.6 ± 16 min). No intraoperative complications were noted. Two patients developed retinal detachment postoperatively and were reoperated. The final visual vision was 20/400 for two patients and 20/50 or better for the other patients.

Conclusion: 23-G TSV allows the surgeon to meet the same objectives as the 20-G technique for the treatment of endophthalmitis.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / administration & dosage
  • Aqueous Humor / microbiology
  • Bacteria / genetics
  • Bacteria / isolation & purification
  • Cataract Extraction
  • Conjunctiva / surgery
  • DNA, Bacterial / analysis
  • Endophthalmitis / microbiology
  • Endophthalmitis / surgery*
  • Eye Infections, Bacterial / microbiology
  • Eye Infections, Bacterial / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Microsurgery / methods*
  • Middle Aged
  • Polymerase Chain Reaction
  • Postoperative Complications*
  • Prospective Studies
  • Suture Techniques*
  • Trabeculectomy
  • Treatment Outcome
  • Visual Acuity / physiology
  • Vitrectomy / methods*
  • Vitreous Body / microbiology


  • Anti-Bacterial Agents
  • DNA, Bacterial