Objective:

We aim to report the anatomical and functional outcomes after endoscopy-guided vitrectomy, in a series of severe endophthalmitis. We also aim to identify two different clinical presentation modes and to compare the outcomes.

Patients & Methods:

Retrospective case study, single center, all patients who underwent endoscopic vitrectomy 20ga (Endo optiks E4 system) for severe endophthalmitis were included. For each case, data were recorded for : etiology, surgical indication, preoperative and postoperative visual acuity, comorbidity factors and postoperative complications and if any additional surgery was performed. Two groups were distinguished, according to their initial presentation mode, results were then compared in terms of complications and visual prognosis to those found in the literature.

Results:

18 patients were included, with mean age 62 ± 19 years. Severe endophthalmitis was straightaway present for 8 cases (group 1). For 10 cases, evolution was considered unfavorable despite adequate medical treatment (groupe 2). There was no statistically significant difference between the two groups (p = 0.55) The endophthalmitis was encountered : after intravitreal injections (4 cases), after intraocular foreign body (n=2), after cataract surgery (n=5), following a trabeculectomy (n=2), after epiretinal membrane peeling (n=3), 1 case of endophthalmitis caused by a corneal infection and 1 case of endogenous leptospirosis. Mean follow-up was 13.7 months. The surgical technique was a complete vitrectomy 20ga under endoscopic visual control. The mean operative time was 70 ± 27 minutes. The causative organism was identified in 72% of cases in vitreous humor samples, among which 77% were gram-positive organisms. In all cases, infection was under control. Moreover, 89% of cases have recovered useful visual acuity.

Conclusion:

The value of endoscopic visualization in ophthalmology has been proven for 30 years, but its miniaturization enhances the current enthusiasm for the use of this instrumentation. When visualization is compromised, endoscopic guided vitrectomy is really useful and thus could help the surgeon to manage those difficult cases. Our anatomical and functional outcomes are encouraging, but we must keep in mind the poor long-term prognosis of severe endophthalmitis.

Contact Details:

Email: martiano.d@gmail.com
Cell Phone: +33624122418