Sir,
I wish to thank Drs Taylor and Aylward for describing their case of presumed bacterial endophthalmitis following 25-gauge vitrectomy.1 Discussion of complications or untoward outcomes ultimately leads to improved patient care.
It would be interesting to know whether scleral depression for examination of the periphery was performed during this case. When performed near the site of a 25-gauge cannula, this technique necessarily causes the cannula to be redirected anteriorly. If the cannula is plugged, this might not disrupt the sclerotomy, but if the cannula contains an instrument in active use such as the vitreous cutter, the manipulation of the instrument could be at odds with the anterior misdirection of the cannula. The consequence could be enlargement of the sclerotomy wound or at least distortion of the normal wound architechture. Similarly, scleral depression can tear the conjunctiva by pulling it posteriorly while it remains anchored at the 25-gauge cannula. From any of these scenarios, one could envision an increased risk of subclinical wound leak.
References
Taylor SRJ, Aylward GW . Endophthalmitis following 25-gauge vitrectomy. Eye 2005; 19: 1228–1229.
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Stewart, J. Wound integrity and the conjunctiva in prevention of endophthalmitis following sutureless 25-gauge vitrectomy. Eye 20, 1490 (2006). https://doi.org/10.1038/sj.eye.6702395
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DOI: https://doi.org/10.1038/sj.eye.6702395