Elsevier

Ophthalmology

Volume 115, Issue 12, December 2008, Pages 2215-2220
Ophthalmology

Original article
Incidence of Endophthalmitis after 20- and 25-Gauge Vitrectomy: Causes and Prevention

https://doi.org/10.1016/j.ophtha.2008.07.015Get rights and content

Purpose

To compare endophthalmitis incidence after inpatient 20-gauge (20-G) and 25-G vitrectomies, and to examine the causes and prevention of postvitrectomy endophthalmitis.

Design

Retrospective, interventional, comparative cohort study.

Participants

Six thousand nine hundred thirty-five consecutive patients undergoing pars plana vitrectomy.

Methods

We compared the incidence of endophthalmitis in 3592 consecutive eyes that underwent 20-G vitrectomy between January 2000 and September 2004, and 3343 consecutive eyes that underwent 25-G vitrectomy between April 2004 and December 2007. For 25-G vitrectomy, 542 eyes with sclerotomies produced by straight incision and 2801 eyes with angled incisions were also compared. From 85 eyes that underwent 20-G vitrectomy and 128 eyes that underwent 25-G vitrectomy, ocular surface irrigation fluid and vitreous samples were collected at the end of surgery for bacterial culture.

Main Outcome Measures

Incidence of postvitrectomy endophthalmitis.

Results

The incidence of postoperative endophthalmitis was 0.0278% (1 of 3592 eyes) for 20-G vitrectomies and 0.0299% (1 of 3343 eyes) for 25-G vitrectomies, with no significant difference. Two eyes developed endophthalmitis after vitrectomy, and visual acuity deteriorated to no light perception despite emergency vitreous surgery. The causative bacteria were methicillin-resistant Staphylococcus aureus and Enterococcus faecali; both were resistant to postoperative antibiotics. In 25-G vitrectomy, the endophthalmitis incidence was 0.18% (1/542 eyes) for straight incision versus 0% (0/2801 eyes) for angled incision, with no significant difference (P = 0.1621). Bacterial contamination rates in ocular surface irrigation fluid and the vitreous were 5.9% (5/85 eyes) and 1.2% (1/85 eyes), respectively, in 20-G vitrectomies, and 5.5% (7/128 eyes) and 2.3% (3/128 eyes) in 25-G vitrectomies, with no significant difference.

Conclusions

The incidence of endophthalmitis was 0.03% for both 20-G and 25-G vitrectomies. This is the first data set to demonstrate no statistically significant difference between endophthalmitis rates in 20-G and 25-G vitrectomy. At the completion of 25-G vitrectomy, the ocular surface irrigation fluid and vitreous were, on rare occasion, contaminated by antibiotic-resistant bacteria. In 25-G vitrectomy, conjunctival irrigation, ensuring sclerotomy closure, and excision of peripheral vitreous may contribute to the prevention of postvitrectomy endophthalmitis.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Patients and Methods

A total of 6935 eyes that underwent vitrectomy at the Surugadai Hospital of Nihon University between January 2000 and December 2007 were studied. The mean patient age was 61.9±12.8 years (range, 1–92). HS performed 70% of the surgeries, and HN and TH the remainder. From January 2000 to September 2004, vitrectomy was conducted on 3592 consecutive eyes using a 20-G vitrectomy system (Accurus 800CS; Alcon Surgical, Fort Worth, TX). From April 2004 to December 2007, 25-G vitrectomy was conducted on

Results

There were no statistically significant differences in baseline characteristics between patients who underwent 20-G vitrectomy and those who underwent 25-G vitrectomy, including the rate of simultaneous cataract surgery (68.7% vs 65.8%), use of intravitreal triamcinolone acetonide (7.7% vs 6.4%), and proportion of proliferative diabetic retinopathy and diabetic macular edema (24.7% vs 25.8%). Among eyes that underwent 25-G vitrectomy with straight incision, 3.5% (19/542 eyes) required

Discussion

The most important finding of this study is that the incidence of endophthalmitis was equally low (0.03%) for both 20-G and 25-G vitrectomies. Because the baseline characteristics of the 2 populations were similar, this result may be considered valid. This is the first data set to demonstrate no statistically significant difference between endophthalmitis rates in 20-G and 25-G vitrectomy, despite other reports indicating a higher incidence for 25-G vitrectomy.14, 15

Postoperative

References (24)

  • A. Samad et al.

    Anterior chamber contamination after uncomplicated phacoemulsification and intraocular lens implantation

    Am J Ophthalmol

    (1995)
  • L. López-Guajardo et al.

    Oblique sclerotomy technique for prevention of incompetent wound closure in transconjunctival 25-gauge vitrectomy

    Am J Ophthalmol

    (2006)

    • Cited by (0)

    Manuscript no. 2008-311.

    Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

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