Vitrectomy for Postoperative Endophthalmitis: Surgical Pearls


ABSTRACT

Endophthalmitis is the most devastating postoperative complication following intraocular surgery. Its incidence is low, but it is not zero, even if the most efficient prophylactic measures are employed. The Endophthalmitis Vitrectomy Study (EVS) recommended that surgery be done only in exceptional cases (visual acuity of light perception), but this conclusion can be seriously challenged on several fronts. First, it is completely illogical since it allows the deadly mix of the pathogen and the body’s immune reaction to it to stay inside the vitreous cavity, bathing the retina for an extended period. Second, the EVS was performed decades ago, and surgical technology has made giant advances since. Third, the EVS defined as vitrectomy a surgery that no more than partial vitrectomy. What truly offers improvement over the EVS results is “CEVE”: Complete and Early Vitrectomy (for Endophthalmitis). “Early” means as soon as the diagnosis is made; and “complete” means that as much of the infiltrated vitreous gel (abscess) is removed as is compatible with safety. CEVE is for the experienced surgeon; this is true even if, in general, earlier cases are much easier to operate on technically and with a reduced risk of surgical complications. This talk will review the steps of CEVE in a methodical fashion, from scraping the corneal epithelium to detaching the posterior cortical vitreous and vacuuming the macular surface.


CONTACT DETAILS

 

Ferenc Kuhn
Saint Johns, United States
Email : fkuhn@mindspring.com
Cell Phone: +19044636428
Work Phone: +19044636428

 

 

 



Giampaolo Gini
Italy / United Kingdom
Email : giampaolo.gini@gmail.com