Outcome of 23-gauge sutureless transconjunctival vitrectomy for endophthalmitis

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Outcome of 23-gauge sutureless transconjunctival
vitrectomy for endophthalmitis

• Dr Colin S.H. Tan

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Acknowledgments

• Dr Hon Kiat WONG
• Dr Francine YANG
• Dr Jong Jian LEE
• The authors have no financial or proprietary
  interests in the subject of this poster

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Introduction

• Endophthalmitis is a potentially devastating eye
  infection
• Postoperative endophthalmitis reported in between
  0.04 to 0/12 of cases
• Vitrectomy may be useful in treatment of
  endophthalmitis, especially with visual acuity of
  light perception or worse.
• No previous report on use of 23-G sutureless
  vitrectomy to treat endophthalmitis

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Objectives

• To review the feasibility and surgical outcomes
  of using 23G transconjunctival vitrectomy for the
  treatment of endophthalmitis

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Methods

• Non-randomized, interventional case series study
• All patients presenting with postoperative
  endophthalmitis over a 1-year period from April
  2005 to March 2006
• Main outcome measures intraoperative and
  posteroperative complications (hypotony, wound
  leak, chemosis)

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Results

• Vitrectomy was performed on 6 patients (4 acute
  and 2 chronic endophthalmitis)
• Mean surgical time 58.3 minutes (range 40 75)
• Mean follow-up 13.2 months (range, 9 17)

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Surgical outcomes

• Thorough clearance of the vitreous base was
  achieved
• No severe postoperative pain
• No wound leak / hypotony
• Mean IOP on 1st postoperative day was 17.3 mmHg
  (SD ? 3.4, range, 12 21 mmHg)
• Mean IOP change -4.2 mmHg compared to the
  preoperative IOP (p0.239)

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Visual outcomes

• 20/40 in 5 of 6 patients (83.3) overall
• 20/40 in 3 of 4 patients (75) with acute
  endophthalmitis
• Final visual acuity (VA) significantly improved
  compared to preoperative VA (p0.026)

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Characteristics of patients
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Discussion

• Advantages of transconjunctival vitrectomy
• Reduced surgical time
• Less postoperative discomfort
• Shorter recovery time
• Concern about postoperative hypotony due to
  sutureless sclerostomy
• Able to clear vitreous base without difficulty
  using 23-gauge instruments

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Conclusion

• 23-gauge transconjunctival vitrectomy can be
  performed safely for both acute and chronic
  endophthalmitis
• Good final visual acuity
• No cases of hypotony or severe complications