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A prospective and nationwide study investigating endophthalmitis following pars plana vitrectomy

Session Details

Session Title: Vitreoretinal Surgery III

Session Date/Time: Friday 12/09/2014 | 08:00-10:00

Paper Time: 09:04

Venue: Boulevard E

First Author: : R.Ling UK

Co Author(s): :    B. Ramasamy   S. Shaw   S. Prasad        

Abstract Details

Purpose:

This is the first nationwide prospective study to investigate the incidence, risk factors, clinical presentation, microbiology, management and outcome of endophthalmitis following pars plana vitrectomy (PPV).

Setting:

All Ophthalmology units in the United Kingdom (surveillance via the British Ophthalmic Surveillance Unit, BOSU).

Methods:

Two years of prospective and nationwide surveillance for cases of presumed infectious endophthalmitis within 6 weeks of pars plana vitrectomy was completed (May 2010 - May 2012). The study obtained case reports via the established British Ophthalmological Surveillance Unit (BOSU) system. Controls (patients who had PPV but no endophthalmitis) were recruited from 9 randomly selected UK centers. Case and control information was obtained via questionnaires. The case definition was, “any case that was diagnosed and managed as having infectious endophthalmitis within 6 weeks of PPV, regardless of microbiology culture status”. PPV performed for dropped nuclear fragment after complicated cataract surgery, open-globe trauma, intraocular foreign body and endophthalmitis were excluded. The incidence of endophthalmitis was calculated based on the number of reported cases that met the diagnostic criteria, divided by the number of PPVs performed in the UK, by both the National Health Service (NHS) and private sectors, based on hospital episode and statistics (HES) data and UK census data.

Results:

Thirty-seven reports were received and 28 cases met the diagnostic criteria for presumed infectious endophthalmitis following PPV. The incidence of endophthalmitis following PPV was 28 cases per 48,433 PPV’s (1 in 1,730 with a 95% CI of 1 in 1,263 to 1 in 2,747). Two hundred and seventy two controls were randomly recruited from 9 UK centers. Smaller gauge port sizes were not found to be a risk. Immunosuppression (OR 19.0, p = 0.001) and pre-operative topical steroids (OR 131.4, p < 0.001) increased the endophthalmitis risk. Operating for retinal detachment was associated with a reduced risk of endophthalmitis (OR 0.10, p = 0.005). Mean age was 61 years and 67% were male. Nineteen cases were 23/25 gauge and 9 cases were 20 gauge. Mean time from surgery to endophthalmitis was 5 days. Blurred vision (85.2%), pain (77.8%) and a hypopyon (77.8%) were the commonest presenting symptoms and signs. Seventeen cases (60.7%) had a positive culture. Culture positive endophthalmitis, relative to culture negative endophthalmitis, was no different with respect to time to presentation, symptoms, signs or outcome. Outcome was poor with 29.6% of eyes being eviscerated or having no perception of light or perception of light.

Conclusions:

Endophthalmitis following PPV is rare. Operating with smaller gauge port sizes does not increase the risk of endophthalmitis. This study helps surgeons promptly identify cases of endophthalmitis following vitrectomy, and informs them about the various management options currently used and the likely outcome of this devastating complication.

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