- 作者：Andrea Govetto ; Gianni Virgili ; Francesca Menchini ; Paolo Lanzetta ; Ugo Menchini
- 刊名：Ophthalmology
- 出版年：2013
- 出版时间：November, 2013
- 年：2013
- 卷：120
- 期：11
- 页码：2286-2291
- 全文大小：437 K
Background
Endophthalmitis is a rare but severe complication of vitrectomy.Clinical Relevance
Post-surgical endophthalmitis is suspected to be more frequent after microincisional (23- and 25-gauge) compared with standard (20-gauge) vitrectomy.
Methods
We conducted a systematic review of studies that compared microincisional and standard vitrectomy by searching MEDLINE and EMBASE up to November 2012. We used the Bayesian meta-analysis method to compute the odds ratio (OR) of endophthalmitis. We conducted subgroup analyses to compare the effect of different incision types and use of perioperative antibiotics.
Results
We identified 3 small randomized and 18 nonrandomized studies that reported 68 cases of endophthalmitis in 148?643 participants. The overall OR of endophthalmitis for microincisional versus standard vitrectomy was 2.3 (95 % credible interval [CrI], 0.8-5.8). We found an increased risk of endophthalmitis using a microincisional straight approach compared with standard vitrectomy (OR, 15.1; 95 % CrI, 2.01-179), but not for a beveled approach (OR, 0.82; 95 % CrI, 0.23-2.28). The OR of studies that reported on mixed microincision was between these 2 values (OR, 4.4; 95 % CrI, 1.32-14.3). We estimated that the overall rate of endophthalmitis with 20-gauge vitrectomy was 3 cases in 10?000 procedures, and the probability that a beveled microincision increases the rate of endophthalmitis to more than 6 or 9 events was small (no more than 5 % or 1 % , respectively).
Conclusions
We did not find an increased risk of endophthalmitis for microincisional vitrectomy compared with standard vitrectomy. The beveled approach seems to be safer than a straight approach, supporting the current recommendation of its adoption in microincisional vitrectomy. However, these findings must be interpreted cautiously because of the small number of endophthalmitis events reported from included studies.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.