Endophthalmitis after pars plana vitrectomy with reused single-use devices: a 13-year retrospective study

Sukhum Silpa-Archa,Kwanchanoke Kumsiang,Janine M Preble

doi:10.1186/s40942-020-00274-5

Abstract

BackgroundTo describe the incidence, clinical characteristics, and treatment outcomes of endophthalmitis after pars plana vitrectomy (PPV) with recycled single-use devices. The recommended sterilization process as well as safety measures are discussed.MethodsMedical charts of patients who developed endophthalmitis after PPV were retrospectively reviewed and reported in a descriptive manner. Cases undergoing PPV for preexisting endophthalmitis or open globe injury were excluded. Data collection included patient demographics, operative details, ocular findings, microbiological profiles, treatment modalities, and visual outcomes.ResultsOver the past thirteen years, a total of 12,989 pars plana vitrectomy operations were included. In total, 13 eyes of 13 cases (0.10%) experienced endophthalmitis after vitrectomy. These occurred in 3 cases (0.11%) using 20-gauge vitrectomy compared to 8 cases (0.09%) using 23-gauge vitrectomy and 2 cases (0.18%) using 25-gauge vitrectomy. There were no statistically significant differences between the 20-gauge and microincisional vitrectomy surgery (MIVS) group (P = 0.64), and the 23- and 25-gauge approach (P = 0.34). Causative pathogens were positive by culture in 5 cases (45%): 3 g-positive cases, 1 g-negative case, and 1 fungus case.ConclusionsThe rate of endophthalmitis in patients who underwent 23-gauge PPV was comparable to those who underwent 25-gauge PPV. With our standardized protocol for instrument sterilization, endophthalmitis rates in those undergoing PPV using recycled single-use instruments were within the range of previously published results in which vitrectomy tools were disposed of after one use.

Highlights

To describe the incidence, clinical characteristics, and treatment outcomes of endophthalmitis after pars plana vitrectomy (PPV) with recycled single-use devices
Demographic and operative data Over a 13-year study period, a total of 12,989 PPVs were performed in our center and 13 eyes (0.10%; 1 in 999 cases) of postvitrectomy endophthalmitis (PVE) were identified in 13 patients
Since 2009, we have changed from sutured vitrectomy (20-gauge) to microincisional vitrectomy surgery (MIVS) including 23-gauge and 25-gauge sutureless vitrectomy

Summary

Introduction

Clinical characteristics, and treatment outcomes of endophthalmitis after pars plana vitrectomy (PPV) with recycled single-use devices. MIVS as a risk of postvitrectomy endophthalmitis (PVE) [3, 4]. As the first report of PVE in the Southeast Asian population, the present study aimed to describe the incidence, clinical characteristics, and treatment outcomes of PVE in the Thai population. A mini-review of previous studies of PVE following MIVS was included in the study. Given cost-saving measures, our institute has been reusing single-use devices for vitrectomy. The present study is the first to compare rates of endophthalmitis after pars plana vitrectomy (PPV) performed with vitrectomy tools disposed of after one use with rates of endophthalmitis after PPV that used recycled single-use vitrectomy tools.

Methods

Results

Discussion

Conclusion