Outcome of 23-gauge sutureless transconjunctival vitrectomy for endophthalmitis

Abstract

Purpose

To review the outcomes of 23-gauge transconjunctival vitrectomy in patients with postoperative endophthalmitis.

Methods

Non-randomized, interventional case series of patients with postoperative endophthalmitis over a 1-year period.

Results

23-gauge transconjunctival vitrectomy was performed on 6 patients with a mean age of 67.7 years without intraoperative or postoperative complications. There were no cases of postoperative hypotony or wound leak. The mean change in IOP was −4.2 mmHg compared to the preoperative IOP (P=0.239). Final VA improved significantly compared to preoperative VA (P=0.062), with VA of at least 20/40 in 5 of 6 patients (83.3%).

Conclusions

23-gauge transconjunctival vitrectomy is a useful technique for treating postoperative endophthalmitis.

Introduction

The advantages of 23-gauge sutureless transconjunctival vitrectomy compared to conventional 20-gauge vitrectomy are shorter surgical^{1, 2, 3} and recovery time,^{1, 4} and less postoperative discomfort.¹ We reviewed the outcome of 23-gauge transconjunctival vitrectomy in patients with postoperative endophthalmitis.

Case report

Over a 1-year period, vitrectomy was performed on six patients (four acute and two chronic endophthalmitis) (Table 1). The mean surgical and follow-up duration were 58.3 min (range: 40–75) and 13.2 months (range: 9–17) respectively.

Table 1 Characteristics of endophthalmitis patients who underwent 23-gauge vitrectomy

In all surgeries, thorough clearance of the vitreous base was achieved. Common findings on the first postoperative day were corneal oedema, conjunctival injection, and subconjunctival haemorrhage. No patient experienced severe pain, postoperative hypotony, or wound leak. The mean intraocular pressure (IOP) on the first postoperative day was 17.3 mmHg (SD±3.4, range: 12–21 mmHg), with a mean change of −4.2 mmHg compared to the preoperative IOP (P=0.239). There were no cases of prolonged postoperative inflammation, or complications such as retinal detachment or macular hole formation.

Final visual acuity (VA) was significantly improved compared to preoperative VA (P=0.026), and was 20/40 or better in 5 of 6 patients (83.3%) overall and 3 of 4 patients (75%) with acute endophthalmitis.

Comment

Our study demonstrates that 23-gauge transconjunctival vitrectomy can be performed safely for both acute and chronic endophthalmitis. Postoperative-wound leak and hypotony have been reported with 25- and 23-gauge transconjunctival vitrectomy systems^{1, 2, 3, 4, 5} and may be associated with the removal of peripheral vitreous gel.¹ No patient in our series developed hypotony or subconjunctival bleb formation after surgery.

Increased flexibility of 25-gauge instruments may make complex surgeries more challenging since torsion of the eye is more difficult.¹ With 23-gauge vitrectomy, we were able to indent the eye and clear the vitreous base thoroughly without difficulty.

Visual acuity improved significantly in our patients, with results similar to or better than that reported in reports of elective vitrectomies using 25-gauge systems.^{3, 4, 5} The poor VA of patient 3 was due to pre-existing glaucoma and macular pucker.

In conclusion, 23-gauge transconjunctival vitrectomy can be performed safely in patients with postoperative endophthalmitis with no complications or hypotony, and good final VA.