Comparison of microbiology and visual outcomes of patients undergoing small-gauge and 20-gauge vitrectomy for endophthalmitis
| Autor: | James C. Folk, David R. P. Almeida, H. Culver Boldt, Shaival S. Shah, Benjamin Bakall, Eric K. Chin, Stephen R. Russell, Vinit B. Mahajan, Karen M. Gehrs |
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| Rok vydání: | 2016 |
| Předmět: |
Pars plana
medicine.medical_specialty Microbiological culture medicine.medical_treatment vitrectomy Vitrectomy Tertiary care Microbiology 03 medical and health sciences 0302 clinical medicine Endophthalmitis Ophthalmology medicine 030212 general & internal medicine Original Research business.industry vitreous biopsy Clinical Ophthalmology Cataract surgery medicine.disease Culture growth medicine.anatomical_structure endophthalmitis 030221 ophthalmology & optometry Etiology business |
| Zdroj: | Clinical Ophthalmology (Auckland, N.Z.) |
| ISSN: | 1177-5483 |
| DOI: | 10.2147/opth.s95906 |
| Popis: | David RP Almeida,1 Eric K Chin,2,3 Shaival S Shah,3 Benjamin Bakall,3 Karen M Gehrs,3 H Culver Boldt,3 Stephen R Russell,3 James C Folk,3 Vinit B Mahajan3,41VitreoRetinal Surgery PA, Minneapolis, MN, 2Retina Consultants of Southern California, Riverside, CA, 3Vitreoretinal Service, Department of Ophthalmology and Visual Sciences, 4Omics Laboratory, University of Iowa, Iowa City, IA, USABackground: The role of pars plana vitrectomy (PPV) for endophthalmitis has evolved over recent decades but the literature is lacking on comparisons between small-gauge and 20-gauge vitrectomy.Objective: To evaluate evolving etiological and microbiological trends in patients undergoing vitrectomy for endophthalmitis and to compare culture-positive rates and visual outcomes between small-gauge (23- and 25-gauge) and 20-gauge instrumentation during vitrectomy for endophthalmitis.Methods: Ten-year retrospective comparative case series and prospective laboratory in vitro testing. Tertiary care academic referral center. Patients who underwent PPV for endophthalmitis between 2003 and 2013. Vitreous biopsies were obtained in all cases. The effect of vitrectomy gauge (20-, 23-, and 25-gauge) and vitreous cutting rate (1,500 and 5,000 cuts per minute) on the viability of bacterial culture was evaluated in an in vitro prospective laboratory investigation.Main outcome measures: Comparison of etiology, microbiology culture-positive rates, and visual outcomes between small-gauge and 20-gauge instrumentation in patients undergoing PPV for infectious endophthalmitis.Results: A total of 61 cases of vitrectomy for endophthalmitis were identified over a 10-year period; of these, 34 were treated with small-gauge (23- and 25-gauge) vitrectomy and 27 were treated with 20-gauge vitrectomy. In the small-gauge group, 12 cases (35.3%) yielded culture-positive results versus 20 cases (74.1%) with culture positivity in the 20-gauge cohort (P=0.002). The most common cause of endophthalmitis was cataract surgery and the most frequently identified organism was coagulase-negative Staphylococci in both groups. There was no significant difference in mean postoperative visual acuities between groups (P=0.33). Etiological trends indicate an increase in endophthalmitis due to intravitreal injection in the small-gauge group (n=9) compared to the 20-gauge group (n=3) (P=0.001). In vitro laboratory testing revealed no significant difference in rates of culture growth for different vitrectomy gauge sizes or vitreous cutting speeds.Conclusion and relevance: Small-gauge vitrectomy for endophthalmitis yields final visual outcomes comparable to 20-gauge instrumentation. A significant difference in culture-positive rates was observed between small-gauge and 20-gauge instrumentation for vitrectomy in endophthalmitis; however, laboratory testing indicates this is not related to either vitreous gauge size or cutter speed. Intravitreal injections are emerging as a common etiology of vitrectomy for endophthalmitis.Keywords: endophthalmitis, vitrectomy, vitreous biopsy |
| Databáze: | OpenAIRE |
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