APR 26, 2011
Disturbing reports emerged recently suggesting increased rates of endophthalmitis after 25-gauge transconjunctival pars plana vitrectomies (PPV); however, other comparative studies found no such increase.
To learn more, researchers with the Pan American Collaborative Retina Study Group conducted a large retrospective study included patients from various institutions in Latin America who underwent 20-, 23- or 25-gauge pars plana vitrectomy (PPV). Of the 35,427 cases reviewed, the five-year post-PPV endophthalmitis incidence rates were 0.020 percent, 0.028 percent and 0.021 percent for 20-, 23-, and 25-gauge PPV, respectively (P = 0.9685). Of the eight eyes that developed endophthalmitis, only two achieved a visual acuity ≥20/200; the rest had a visual acuity of light perception or no light perception. In addition, three of the eight eyes developed phthisis.
The authors write that, while these results support the notion that small-gauge transconjunctival PPV does not increase the rates of post-PPV endophthalmitis, they do underscore the need for preventive measures regarding small-gauge transconjunctival PPV and endophthalmitis. Proper wound construction is of paramount importance. Surgeons should be vigilant in identifying and removing all vitreous wicks. If there is any doubt as to the integrity of the wound, they advise placing a suture across the sclerotomy.