Our Summary

This research was a study of patients who developed a rare but serious eye infection, known as acute endophthalmitis (AE), after having a specific type of eye surgery known as small-gauge pars plana vitrectomy (PPV). The study looked back at patients who had this condition between 2013 and 2021. Before treating these patients, the doctors took a sample of the jelly-like substance in their eyes (vitreous biopsy) to help decide the best treatment.

The patients were grouped into two: those who had PPV within three days of being diagnosed (Urgent-PPV) and those who did not have the surgery urgently (Other-treatment [Tx]). The main thing the researchers looked at was how well the patients could see (best-corrected visual acuity or BCVA) six months after treatment.

In total, 21 patients were studied. The most common reason for having the PPV surgery was an issue with a thin layer on the retina (epiretinal membrane), found in 48% of cases. The overall chance of getting AE after this surgery was 0.074%. Over half (57%) of the patients had a positive culture, meaning that bacteria or other microorganisms were found in the eye samples.

In terms of how well the patients could see six months after treatment, there was no significant difference between those who had urgent surgery and those who did not. Most of the patients (71%) did not have their surgical wounds stitched up. About a quarter of patients did not have a tamponade (a procedure to seal the eye), while 38% had a partial tamponade.

The study suggests that whether or not a tamponade is used, and whether the surgical wounds are stitched up, might be important factors to consider in patients who develop AE after small-gauge PPV. However, more research is needed to confirm these findings.

FAQs

  1. What were the risk factors and outcomes of acute endophthalmitis following small-gauge pars plana vitrectomy as described in the study?
  2. What was the most common indication for pars plana vitrectomy and what was its incidence?
  3. How may tamponade agents and sclerotomy suturing be important factors in evaluating post-small-gauge PPV-associated AE?

Doctor’s Tip

A doctor might tell a patient about vitrectomy that the type of tamponade agent used and whether sclerotomy wounds are sutured are important factors to consider in order to reduce the risk of developing acute endophthalmitis following the procedure. It is important to discuss these factors with your surgeon and follow their recommendations for optimal outcomes.

Suitable For

Patients who are typically recommended vitrectomy include those with conditions such as retinal detachment, macular hole, epiretinal membrane, diabetic retinopathy, proliferative vitreoretinopathy, vitreous hemorrhage, and intraocular infections. These patients may benefit from vitrectomy surgery to improve visual outcomes and prevent further progression of their ocular condition.

Timeline

Before vitrectomy:

  1. Patient presents with a retinal issue such as epiretinal membrane.
  2. Patient undergoes diagnostic tests and consultations to determine the need for vitrectomy.
  3. Vitreous biopsy is performed to confirm diagnosis and rule out infection.
  4. Patient is divided into cohorts based on urgency of PPV (Urgent-PPV vs. Other Tx).
  5. Treatment plan is determined based on findings and urgency of the situation.

After vitrectomy:

  1. Vitrectomy is performed, with or without urgent intervention.
  2. Post-operative care and follow-up appointments are scheduled.
  3. Best-corrected visual acuity (BCVA) is monitored over time.
  4. Sclerotomy wounds may or may not be sutured, depending on the case.
  5. Tamponade agents are used to stabilize the retina, with different outcomes depending on the type and extent of tamponade.
  6. Further studies may be needed to better understand the factors influencing post-PPV endophthalmitis and outcomes.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with vitrectomy surgery?
  2. What is the typical recovery process and timeline after vitrectomy surgery?
  3. How will my vision be affected immediately after the surgery, and what can I expect in the long term?
  4. What type of tamponade agent will be used during the surgery, and how does it affect the risk of post-operative complications like endophthalmitis?
  5. Will my sclerotomy wounds be sutured after the surgery, and how does this impact the risk of infection?
  6. What steps will be taken to prevent post-operative infections like endophthalmitis?
  7. How will my visual acuity be monitored and measured after the surgery?
  8. What should I do if I experience any changes or complications in my vision after the surgery?
  9. Are there any specific lifestyle changes or precautions I should take during the recovery period to optimize my healing and outcomes?
  10. Are there any alternative treatment options to vitrectomy that I should consider or be aware of?

Reference

Authors: Vagaggini T, Adams OE, Curran CD, Prairie ML, Baker MJ, Sastry A, Ryan EH, Parke DW 3rd, Mittra RA, Tang PH. Journal: Ophthalmic Surg Lasers Imaging Retina. 2023 Jul;54(7):395-400. doi: 10.3928/23258160-20230614-01. Epub 2023 Jun 1. PMID: 37418667