Incidence of endophthalmitis following vitreoretinal surgery

Abstract

The incidence of endophthalmitis following pars plana vitrectomy remains low.

Reply to Mansoor et al

“…Although we acknowledge the help of an assistant in such complex procedures, we are also aware of the fact that some incidents wherein subretinal dye injection had occurred were due to accidental forceful dye injection by the assistant, where the surgeon had no control of the dye flow, as documented by Arevalo and Garcia. 3 We agree with the fact that for heavy liquids and triamcinolone the transvitrectomy injection may be a safe method, but in situations where the dye has to be injected in a more controlled manner and where the force of the injection itself may be harmful to the retina, we propose that the backflush technique still holds its merits.…”

“…2 The only UK evidence quotes 0.038%. 3 Therefore, the estimated rate of postoperative endophthalmitis of 0.040% for UK-based 23G TSV is acceptable when compared with these numbers. Obtaining a more accurate rate would require a prospective national audit with an open reporting system for complications.…”

A review of endophthalmitis following vitrectomy

“…2 per 5278 1 in 2639 (0.03%) [36] Review TSV after switching to angled rather than straight incisions and also displacing the conjunctiva -relative to their prior series the rate was lower for 25-gauge (one in 789), and no difference was observed between 20-gauge (one in 4403) versus 23-gauge (one in 3362) [42].…”

“…Other studies have yielded more cases of endophthalmitis following vitrectomy since larger numbers of operations were retrospectively reviewed [31][32][33][34][35][36]. Despite several years of observation, only a handful of cases are observed, not only owing to the rarity of the complication, but also owing to the study area being relatively small and the concern that with retrospective review cases are missed.…”

“…Secondly, if the operation is for proliferative diabetic retinopathy requiring challenging procedures such as delamination, the operation is likely to be longer with more instruments passing in and out of the eye and therefore locally increasing the risk of infection directly. There is a recurrent trend in several studies where the proportion of patients with endophthalmitis following vitrectomy are more likely to have diabetes than the proportion of the study sample itself -see Table 5 [ [31][32][33][34][35][36][39][40][41]43]. However, in the same study set, these cases are not compared with controls (patients having vitrectomy but not getting endophthalmitis), so no clear statistically significant link between diabetes and endophthalmitis has been demonstrated.…”