ENDOPHTHALMITIS AFTER TRANSCONJUNCTIVAL PARS PLANA VITRECTOMY: A 6-year Experience Without Prophylactic Intraoperative Subconjunctival Antibiotics

Retina. 2021 Mar 1;41(3):531-537. doi: 10.1097/IAE.0000000000002905.

Abstract

Purpose: This study aimed to investigate the incidence and risk factors of endophthalmitis after transconjunctival pars plana vitrectomy (PPV) without intraoperative subconjunctival antibiotics.

Design: Retrospective, consecutive case series at a single institution.

Methods: Consecutive cases of transconjunctival 25-gauge PPV without intraoperative subconjunctival antibiotics performed by three retina surgeons at a single surgical site at the Dean McGee Eye Institute from 2012 to 2018 were reviewed.

Results: Of 4,263 cases of PPV without intraoperative subconjunctival antibiotics, five cases (0.117%, 5/4,263) of post-PPV endophthalmitis were identified. Of these five cases, four cases (80%, 4/5) received combined cataract extraction or secondary intraocular lens implantation at the time of PPV. The incidence of endophthalmitis in isolated PPV was 0.027% (1/3,606 cases), whereas the incidence in combined PPV with anterior segment procedures was 0.608% (4/657 cases). Risk factors for endophthalmitis included diabetes mellitus, which was present in 80% of patients with endophthalmitis (4/5 cases). Causative organisms were identified in four of the five cases (80%), including Staphylococcus epidermidis (N = 3) and Propionibacterium acnes (N = 1).

Conclusion: Performing transconjunctival PPV alone with standard preparation using povidone-iodine and postoperative topical antibiotics for 1 week without intraoperative subconjunctival antibiotics did not lead to an increase in incidence of postoperative endophthalmitis (1 per 3,606 cases).

MeSH terms

  • Anti-Bacterial Agents / administration & dosage
  • Antibiotic Prophylaxis
  • Conjunctiva
  • Endophthalmitis / epidemiology*
  • Endophthalmitis / prevention & control
  • Eye Infections, Bacterial / epidemiology*
  • Eye Infections, Bacterial / prevention & control
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Injections
  • Intraoperative Care*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Surgical Wound Infection / epidemiology*
  • Surgical Wound Infection / prevention & control
  • Time Factors
  • United States / epidemiology
  • Vitrectomy / adverse effects*

Substances

  • Anti-Bacterial Agents