- 作者：Allen Y.H. Hu ; Jean-Louis Bourges ; Sumit P. Shah ; Anurag Gupta ; Christine R. Gonzales ; Scott C.N. Oliver ; Steven D. Schwartz
- 刊名：Ophthalmology
- 出版年：2009
- 出版时间：July 2009
- 年：2009
- 卷：116
- 期：7
- 页码：1360-1365
- 全文大小：352 K
Objective
Recent retrospective analyses have suggested that postoperative endophthalmitis may be more frequent with 25- than 20-gauge pars plana vitrectomy (PPV). Because the infection risk may depend on the suturing status of the sclerotomy, and the perioperative anti-infection protocol, we compared the incidence rate of endophthalmitis after sutureless 25-gauge versus sutured 20-gauge PPV on a large cohort of patients operated with a standardized perioperative anti-infection protocol.Design
Retrospective comparative case series.
Participants
Consecutive patients who underwent 20- or 25-gauge PPVs at a single center over a multi-year period.
Methods
We analyzed 3597 consecutive PPVs. Patients with a pre-PPV diagnosis of endophthalmitis, PPVs performed for implantation of drug delivery devices, or 25-gauge PPVs with all sclerotomies sutured closed were excluded. Patients with ≥1 week of follow-up were divided into 2 study groups by sclerotomy status at the end of surgery: the 20-gauge group had 3 sutured 20-gauge sclerotomies, and the 25-gauge group had ≥1 unsutured 25-gauge sclerotomy. Endophthalmitis was defined by clinical criteria independent of microbiological results.
Main Outcome Measures
The incidence of endophthalmitis was compared between 25- versus 20-gauge groups.
Results
Of 3372 PPV surgeries meeting inclusion and exclusion criteria, 1948 and 1424 surgeries were 20- and 25-gauge PPVs, respectively. Average age (± standard deviation) of patients was 54.6 (± 22.6) and 64.4 (± 16.5) years in the 20- and 25-gauge PPV groups, respectively (P<0.0001). Median post-PPV follow-up time was not significantly different between the 2 groups (12.5 vs 13.0 months; P = 0.69). Endophthalmitis was observed in 1 patient (0.07 % ; 95 % confidence interval, 0 % –0.21 % ) from the 25-gauge group and none in the 20-gauge group (P = 0.42; Fisher exact test, 2-tailed). The use of air/gas endotamponade (P<0.0001) and intravitreal triamcinolone (P<0.001) was more common in 25- versus 20-gauge PPV.
Conclusions
The incidence of endophthalmitis was low in both groups. We were unable to show a significant difference in the incidence of endophthalmitis between sutureless 25-gauge and sutured 20-gauge PPV, and conclude that a careful perioperative anti-infection protocol may reduce 25-gauge PPV endophthalmitis risk to that of 20-gauge PPV.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found after the references.