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Gas exchange after microincision vitrectomy may reduce endophthalmitis risk
Retina. 2011;31(8):1513-1517.
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Gas exchange at the end of microincision vitrectomy for macular hole appeared to minimize the incidence of postoperative endophthalmitis, a large study found.
"Microincision, sutureless vitrectomy using a 25-gauge or 23-gauge system has become an increasingly popular method for performing a vitrectomy," the study authors said. "Sutureless vitrectomy has multiple advantages. However, the potential for wound leakage and postoperative hypotony exist. Moreover, there have been multiple reports suggesting an increased rate of postoperative endophthalmitis."
The retrospective chart review included 2,336 eyes that underwent 23-gauge or 25-gauge microincision sutureless vitrectomy with SF6 or C3F8 gas endotamponade for macular hole over a 2-year period.
Most procedures involved 23-gauge pars plana vitrectomy. All eyes had near-complete or complete gas-fluid exchange at the end of surgery; C3F8 was the most commonly used endotamponade agent.
The primary outcome measure was occurrence of acute postoperative endophthalmitis less than 6 weeks after surgery.
Study results showed postoperative endophthalmitis in one patient (0.04%), who was treated with intravitreal vancomycin and topical vancomycin and tobramycin. The macular hole was closed but significant cataract developed at 4 months, resulting in best corrected visual acuity of 20/300.
Further study is needed to make a definitive treatment recommendation, the authors said.