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Endophthalmitis more likely with 25 gauge than 20 gauge vitrectomy, study finds
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LAS VEGAS — Using 25-gauge vitrectomy instrumentation may increase the risk of endophthalmitis by as much as 12 times compared to 20 gauge instruments, according to a study presented here.
Derek Y. Kunimoto, MD, JD, and colleagues reviewed the occurrence of endophthalmitis in 5,498 vitrectomies performed over 2 years with 20- and 25-gauge instrumentation. He discussed the results of their study at the American Academy of Ophthalmology meeting.
The researchers found only one case of endophthalmitis among 4,268 procedures performed using 20-gauge instrumentation (0.018%), compared to seven cases among 1,158 procedures performed with 25-gauge instruments (0.23%).
"This is a striking and significant difference. It strongly suggests surgeons must make changes with the 25-gauge technique," he said.
Dr. Kunimoto theorized that these differences are due not to the technology but rather to surgical technique, which can be modified.
"I want to emphasize that 20-gauge vitrectomy can serve as a control to 25-gauge vitrectomy because the same surgeons who demonstrated an extremely low endophthalmitis rate for the 20-gauge vitrectomies are the ones performing the 25-gauge cases," he said.
The different rates of infection could be attributed to wound formation, lack of wound closure, early postoperative hypotony or fluid flow, Dr. Kunimoto said. He offered some suggestions for avoiding postoperative infections: The surgeon should displace the conjunctiva during sclerotomy, bevel the sclerotomy wound, spend a few extra moments searching for wound leaks, carefully monitor air-fluid exchange and place sutures in the sclerotomies.
"These results must be kept in perspective," Dr. Kunimoto said. "As surgeons we must all realize that 25-gauge surgery is still an evolving technique."