Incidence, microbiology, and outcomes of endophthalmitis after 111,876 pars plana vitrectomies at a single, tertiary eye care hospital

<div><p>Purpose</p><p>To describe the incidence, risk factors, clinical presentation, causative organisms, and outcomes in patients with endophthalmitis following pars plana vitrectomy (20G and minimally invasive vitrectomy surgery (MIVS).</p><p>Methods</p><p>Of 111,876 vitrectomies (70,585 20-G 41,291 MIVS) performed, 45 cases developed acute-onset, postoperative endophthalmitis.</p><p>Results</p><p>The rate of culture positive and culture negative endophthalmitis was 0.021% (2.1/10,000 surgeries) and 0.019% (1.9/10,000 surgeries) overall, 0.031% (3.1/10,000 surgeries) and 0.025% (2.5/10,000 surgeries) in 20G, and 0.005% (0.5/10,000 surgeries) and 0.007% (0.7/10,000 surgeries) in the MIVS group respectively. Potential predisposing factors were as follows: diabetes, 46.7%; vitrectomy for vascular retinopathies, 44.4%; and vitrectomy combined with anterior segment surgeries, 35.5%. The culture proven rates were 53.3% overall, 55.0% for 20G and 40.0% for MIVS. The most common organism was <i>Pseudomonas aeruginosa</i> for 20G. <i>Klebsiella and Staphylococcus aureus</i> were isolated in the two culture positive cases in MIVS group. The follow-up period for the patients with endophthalmitis was 586.14 ± 825.15 days. Seven were lost to follow up beyond one week. Of the remaining 38, 13 (34.2%) cases had a favorable visual outcome (i.e., best-corrected visual acuity [BCVA] > 5/200) and 24 (63.2%) had unfavorable visual outcome (BCVA < 5/200). Group with culture test results negative had significantly better outcomes (<i>P</i> < 0.05) as compared to those with positive.</p><p>Conclusions</p><p>MIVS does not increase the risk of endophthalmitis. Outcomes are poor despite appropriate treatment, particularly in cases with culture results positive.</p></div

Comparison of clinical profile of post vitrectomy endophthalmitis with historical information on post cataract surgery endophthalmitis.

<p>Comparison of clinical profile of post vitrectomy endophthalmitis with historical information on post cataract surgery endophthalmitis.</p

Functional outcome of patients with endophthalmitis in various groups.

<p>Functional outcome of patients with endophthalmitis in various groups.</p

Flow-chart showing the staining, culture and PCR results in various specimen.

<p>Flow-chart showing the staining, culture and PCR results in various specimen.</p

Baseline characteristics of patients with endophthalmitis in 20G vs MIVS group.

<p>Baseline characteristics of patients with endophthalmitis in 20G vs MIVS group.</p

Microbiological profile of ocular specimen in cases with post-operative endophthalmitis.

<p>Microbiological profile of ocular specimen in cases with post-operative endophthalmitis.</p

Incidence of post-operative endophthalmitis after vitreous surgery using 20G Vs MIVS vitrectomy.

<p>Incidence of post-operative endophthalmitis after vitreous surgery using 20G Vs MIVS vitrectomy.</p