Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Incidence of post vitrectomy endophthalmitis in India – A multicentric study by VRSI study Group

Eye volume 37, pages 2915–2920 (2023)Cite this article

Subjects

Abstract

Introduction

The incidence of post vitrectomy endophthalmitis (PVE) is reported to be between 0.02 and 0.84%. Resterilization of single use instruments is a common practice amidst developing countries to make it more affordable to the patients by reducing the cost of the surgery and also reduce the environmental hazard. The aim of our study is to evaluate the incidence of PVE amidst existing sterilization practices of reused instruments in multiple vitreoretinal centres in India.

Methodology

Centres with an endophthalmitis tracking system were invited to participate in a survey. Twenty-five centres were sent a questionnaire via email. The questionnaire included details about the institution, number of vitrectomies performed in a year, sterilization practices followed pre-operatively, intraoperatively and postoperatively, incidence of endophthalmitis and instrument reuse policies.

Results

A total of 29 cases of endophthalmitis were reported out of the 47,612 vitrectomies performed across various centres. The mean incidence of endophthalmitis was 0.06%. There was no difference in the rates of endophthalmitis based on various pre-operative, intraoperative or postoperative prophylactic measures. Nearly 80% of the centres change most of the instruments after every case, while the rest reused. The mean number of times a cutter was being reused until discarded was 4.7. Nearly 76% followed a performance-based protocol, and the remaining 24% had a fixed protocol for the number of times an instrument can be reused before discarding it.

Conclusion

PVE rates are not significantly different in India despite the multiuse of single use instruments. The purpose of this paper is not to suggest an alternate protocol but to creating one in the future with these results in mind, to rationalise the use of single use instruments, make VR surgery more affordable and also have a positive impact on the carbon footprint of consumables in surgery.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Graphs depicting rate of endophthalmitis.

Similar content being viewed by others

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Lemley CA, Han DP. Endophthalmitis: A review of current evaluation and management. Retina. 2007;27:662–80. https://doi.org/10.1097/IAE.0b013e3180323f96

    Article  PubMed  Google Scholar 

  2. Bhende M, Raman R, Jain M, Shah PK, Sharma T, Gopal L, et al. Incidence, microbiology, and outcomes of endophthalmitis after 111,876 pars plana vitrectomies at a single, tertiary eye care hospital. PLoS ONE. 2018;13:e0191173.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Dave VP, Pathengay A, Basu S, Gupta N, Basu S, Raval V, et al. Endophthalmitis after pars plana vitrectomy: clinical features, risk factors, and management outcomes. Asia Pac J Ophthalmol. 2016;5:192–5.

    Article  Google Scholar 

  4. Shi XY, Zhao HS, Wei WB. Analysis of post-operative endophthalmitis after pars plana vitrectomy: A 10-year experience at a single center. Chin Med J (Engl). 2013;126:2890–3.

    PubMed  Google Scholar 

  5. Silpa-Archa S, Kumsiang K, Preble JM. Endophthalmitis after pars plana vitrectomy with reused single-use devices: A 13-year retrospective study. Int J Retin Vitreous. 2021;7:2.

    Article  Google Scholar 

  6. Kunimoto DY, Kaiser RS, Wills Eye Retina Service. Incidence of endophthalmitis after 20- and 25-gauge vitrectomy. Ophthalmology 2007;114:2133–7.

    Article  PubMed  Google Scholar 

  7. Simanjuntak GW, Djatikusumo A, Adisasmita A, Nadjib M, Mailangkay H, Hussain N. Cost analysis of vitrectomy under local versus general anesthesia in a developing country. Clin Ophthalmol. 2018;12:1987–91.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Framme C, Franz D, Mrosek S, Helbig H. Kosteneffizienz von netzhaut- und glaskörperchirurgischen Eingriffen mittels ppV unter DRG-Bedingungen [Cost recovery for the treatment of retinal and vitreal diseases by pars plana vitrectomy under the German DRG system]. Ophthalmologe 2007;104:866–74.

    Article  CAS  PubMed  Google Scholar 

  9. Nicod E, Jackson TL, Grimaccia F, Angelis A, Costen M, Haynes R, et al. Direct cost of pars plana vitrectomy for the treatment of macular hole, epiretinal membrane and vitreomacular traction: A bottom-up approach. Eur J Health Econ. 2016;17:991–9.

    Article  PubMed  Google Scholar 

  10. Thiel CL, Schehlein E, Ravilla T, Ravindran RD, Robin AL, Saeedi OJ, et al. Cataract surgery and environmental sustainability: Waste and lifecycle assessment of phacoemulsification at a private healthcare facility. J Cataract Refract Surg. 2017;43:1391–8.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Carbon Footprint Update for NHS in England 2012. Cambridge, UK: Sustainable Development Unit; 2013. [Accessed September 25, 2017].

  12. Eckelman MJ, Sherman J. Environmental impacts of the U.S. health care system and effects on public health. PLoS One 2016;11:e0157014.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Berkowitz ST, Sternberg P Jr, Patel S. Cost analysis of routine vitrectomy surgery. Ophthalmol Retin. 2021;5:496–502.

    Article  Google Scholar 

  14. Zacharias LC, da Silva Conci L, Megnis BP, Falabretti JG, Dos Santos Rodrigues Neto T, da Silva Neto ED, et al. Safety and cost-effectiveness of single-use endolaser probe reprocessing in vitreoretinal surgery. Int J Retin Vitr. 2021;7:22. https://doi.org/10.1186/s40942-021-00292-x

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sankara Eye Hospital, Bengaluru, Karnataka, India

    Payal Naresh Shah, Divyansh K. Mishra, Mahesh P. Shanmugam & Rajesh Ramanjulu

  2. Medical Research Foundation, Chennai, Tamil Nadu, India

    Manisha Agarwal

  3. Dr Shroff’s Charity Eye Hospital, New Delhi, India

    Pradeep Susvar

  4. Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India

    Alok C. Sen

  5. L V Prasad Eye Institute, Hyderabad, Telangana, India

    Vivek Dave

  6. Aravind Eye Hospital, Coimbatore, Tamil Nadu, India

    Veerapan Saravanan

  7. Aravind Eye Hospital, Madurai, Tamil Nadu, India

    Naresh Kannan

  8. Disha Eye Hospital, Kolkata, West Bengal, India

    Tushar Sinha

  9. Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India

    Manavi D. Sindal

  10. Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Simar Rajan Singh & Vishali Gupta

  11. Sankara Eye Hospital, Guntur, Andhra Pradesh, India

    Madhu Kumar Rajanna

  12. M M Joshi Eye Institute, Hubballi, Karnataka, India

    Apoorva G. Ayachit

  13. Aravind Eye Hospital, Chennai, Tamil Nadu, India

    Aditya Maitray

  14. Narayana Nethralaya, Bengaluru, Karnataka, India

    Naresh Kumar Yadav

  15. Giridhar Eye Institute, Kochi, Kerala, India

    Divya Balakrishnan

  16. Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India

    Eesh Nigam

  17. Centre for Sight, New Delhi, India

    Ritesh Narula

  18. Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India

    Syed M. A. Khadar

  19. Shroff Eye Centre, New Delhi, India

    Neelam Atri

  20. Thind Eye Hospital, Jalandhar, Punjab, India

    Sangeet Mittal

  21. Retina Institute Of Karnataka, Bengaluru, Karnataka, India

    Hemanth Murthy

  22. Sankara eye hospital, Coimbatore, Tamil Nadu, India

    Prabhu Shanker Mahalingam

  23. Amrita Institute of Medical Sciences, Kochi, Kerala, India

    Gopal S. Pillai

  24. Retina Foundation, Ahmedabad, Gujarat, India

    Manish Nagpal

  25. Aditya Jyot Eye Hospital (P) Limited (A Unit Of Dr Agarwals Eye Hospital), Mumbai, Maharashtra, India

    Jaydeep Walinjkar

  26. Pink city eye and retina center, Jaipur, Rajasthan, India

    Abhishek Kothari

Authors
  1. Payal Naresh Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Divyansh K. Mishra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mahesh P. Shanmugam
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Manisha Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pradeep Susvar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alok C. Sen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rajesh Ramanjulu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Vivek Dave
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Veerapan Saravanan
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Naresh Kannan
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Tushar Sinha
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Manavi D. Sindal
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Simar Rajan Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Madhu Kumar Rajanna
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Apoorva G. Ayachit
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Aditya Maitray
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Naresh Kumar Yadav
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Divya Balakrishnan
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Eesh Nigam
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Ritesh Narula
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Syed M. A. Khadar
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Neelam Atri
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Sangeet Mittal
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Hemanth Murthy
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Prabhu Shanker Mahalingam
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. Gopal S. Pillai
    View author publications

    You can also search for this author in PubMed Google Scholar

  27. Manish Nagpal
    View author publications

    You can also search for this author in PubMed Google Scholar

  28. Jaydeep Walinjkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  29. Vishali Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  30. Abhishek Kothari
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the VRSI Study Group

Contributions

PNS: Review of study design, conducting review of literature, data analysis, drafting the manuscript, editing and revising, and submission process. DKM: Study design, writing the study protocol, data collection, submission to institutional review board, manuscript writing, and editing. MPS: Proposed the study idea and design, overall supervision of the study, revising it critically for important intellectual content, final approval of the study. MA: Study design, review of literature, data acquisition, and final approval of the version to be published. PS: data acquisition and final approval of the version to be published. ACS: data acquisition and final approval of the version to be published. RR: data acquisition and final approval of the version to be published. VD: data acquisition and final approval of the version to be published. VS: data acquisition and final approval of the version to be published. NK: data acquisition and final approval of the version to be published. TS: data acquisition and final approval of the version to be published. MDS: data acquisition and final approval of the version to be published. SRS: data acquisition and final approval of the version to be published. MKR: data acquisition and final approval of the version to be published. AGA: data acquisition and final approval of the version to be published. AM: data acquisition and final approval of the version to be published. NKY: data acquisition and final approval of the version to be published. DB: data acquisition and final approval of the version to be published. EN: data acquisition and final approval of the version to be published. RN: data acquisition and final approval of the version to be published. SMK: data acquisition and final approval of the version to be published. NA: data acquisition and final approval of the version to be published. SM: data acquisition and final approval of the version to be published. HM: data acquisition and final approval of the version to be published. PSM: data acquisition and final approval of the version to be published. GSP: data acquisition and final approval of the version to be published. MN: data acquisition and final approval of the version to be published. JW: data acquisition and final approval of the version to be published. VG: data acquisition and final approval of the version to be published. AK: Study design, data acquisition, and final approval of the version to be published.

Corresponding author

Correspondence to Mahesh P. Shanmugam.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shah, P.N., Mishra, D.K., Shanmugam, M.P. et al. Incidence of post vitrectomy endophthalmitis in India – A multicentric study by VRSI study Group. Eye 37, 2915–2920 (2023). https://doi.org/10.1038/s41433-023-02430-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41433-023-02430-1

This article is cited by

Search

Advanced search

Quick links