Session Title: Free Paper Session 13: Vitreoretinal Surgery IV
Session Date/Time: Friday 08/09/2017 | 14:30-16:00
Paper Time: 14:42
Venue: Room 117
First Author: : M.Bhende INDIA
Co Author(s): : R. Raman M. Jain P. Shah T. Sharma P. Bhende L. Gopal
To describe the incidence of endophthalmitis (20G and minimally invasive vitreo-retinal surgery [MIVS]), risk factors, clinical presentation, causative organisms and outcomes, (both visual and anatomical) in patients with endophthalmitis following pars plana vitrectomy from a single centre.
Retrospective interventional consecutive case series of endophthalmitis following pars plana vitrectomy at a vitreoretinal setup in Chennai, India
: Of 11876 eligible cases, 45 cases who developed acute-onset, post-opera- tiveendophthalmitis were identified. For cross-validation of our data, the microbiology department endophthalmitis surveillance log was reviewed. Data collected included demographic details, immune status, indication for vitrectomy, surgical details, clinical presentation, microbiological results and outcomes.
Of 111876 vitrectomies done during the study period, 70585 underwent 20G surgery and 41291 underwent MIVS. The incidence of clinically evident and culture-proven post-vitrectomy endophthalmitis was 0.040% (4.0 per 10,000 surgeries) and 0.021% (2.1 per 10,000 surgeries) respectively. Potential predisposing factors were: diabetes, 46.7%; perioperative steroids (both topical and systemic), 40.0%; vitrectomy for vascular retinopathies, 44.4%; combined with anterior segment surgeries 35.5%. Compared to post-cataract endophthalmitis, post-vitrectomy endophthalmitis patients presented earlier (p=0.212), had fibrin (p<0.001) and varied intra-ocular pressure (p<0.001). Corneal ulcer and scleritis were seen in 1 and 2 cases respectively. The mean number of samples obtained was 1.4 per patient. 53.3% of cases were culture positive with gram negative bacteria being the most common microorganisms, with highest sensitivity to amikacin (81.8%) and ciprofloxacin (81.8%). Mean follow-up was 586.14 ± 825.15 days. Overall 13 (34.2%) had a favourable visual outcome i.e. best-corrected visual acuity better than 5/200, and 24 (63.2%) had unfavourable visual outcome (BCVA <5/200). 5( 13.1%) and 10(26.3%) patients had best corrected vision better than or equal to 6/18 and 6/60 respectively. Globe salvage was possible in 27 (71%) cases. Culture negative group had significantly better outcomes (p<0.05) compared to culture positive group.
Using a large data-base from a single-centre, we showed MIVS does not increase the risk of endophthalmitis. Clinical presentation is different from post cataract surgery endophthalmitis. Outcomes are poor despite appropriate treatment, particularly in culture positive cases.