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Study finds no difference in endophthalmitis risk after 20- or 25-gauge vitrectomy

Ophthalmology. 2008. doi:10.1016/j.ophtha.2008.07.015.

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A retrospective, interventional, comparative cohort study of 6,935 consecutive patients in Japan undergoing either 20- or 25-gauge vitrectomy has found no difference in risk of postoperative endophthalmitis.

The study is the first to report no difference in risk after the two surgeries. Other studies have identified significantly higher rates of bacterial complications after 25-gauge vitrectomy.

Researchers said that intraoperative irrigation of the conjunctiva and closing the scleral wound, as well as conducting peripheral vitrectomy, could be important in preventing postoperative endophthalmitis with 25-gauge vitrectomy.

Of the 3,592 eyes in the 20-gauge cohort, postoperative endophthalmitis developed in one eye (0.0278%) caused by methicillin-resistant Staphylococcus aureus. There was one case of endophthalmitis due to Enterococcus faecalis in the 3,343 eyes that underwent 25-gauge vitrectomy (0.0299%); intraoperative triamcinolone was not used during the case. There was no statistically significant difference in risk of endophthalmitis between the two cohorts.

Microbial contamination was found in five of 85 (5.9%) irrigation fluid samples and one of 85 (1.2%) vitreous samples after 20-gauge vitrectomy; microbial contamination was found in seven of 128 (5.5%) irrigation samples and three of 128 (2.3%) vitreous samples after 25-gauge surgery. There were no significant differences between the groups.