Endophthalmitis following pars plana vitrectomy: a literature review of incidence, causative organisms, and treatment outcomes

Figures & data

Figure 1 Anterior segment photograph of a patient with endophthalmitis following pars plana vitrectomy operated for rhegmatogenous retinal detachment. Cultures were positive for Bacillus cereus. Visual acuity was light perception after treatment.

Table 1 Incidence of endophthalmitis following pars plana vitrectomy in 20 G surgery

Reference	Year	Case occurrence	Incidence
Ho and Tolentino^Citation6	1984	4/2,817	0.14%
Cohen et al^Citation8	1995	18/12,216	0.15%
Aaberg et al^Citation7	1998	3/6,557	0.04%
Zhang et al^Citation9	2003	3/7,000	0.04%
Eifrig et al^Citation10	2004	6/15,326	0.03%
Sakamoto et al^Citation45	2004	1/1,886	0.05%
Joondeph et al^Citation11	2005	5/10,397	0.04%
Mollan et al^Citation12	2009	2/5,278	0.03%
Chen et al^Citation17	2009	1/3,046	0.03%
Scott et al^Citation21	2011	1/4,403	0.02%

Table 2 Incidence of endophthalmitis in transconjunctival sutureless vitrectomy

Reference	Year	Case occurrence	Incidence
Shaikh et al^Citation16	2007	2/129	1.55%
Kunimoto and Kaiser^Citation15	2007	1/443	0.22%
Scott et al^Citation18	2008	1/119	0.84%
Shimada et al^Citation19	2008	1/3,343	0.03%
Chen et al^Citation17	2009	1/431	0.23%
Hu et al^Citation20	2009	1/1,424	0.07%
Scott et al^Citation21	2011	2/4,151	0.04%
Mutoh et al^Citation46	2012	4/502	0.79%

Table 3 Risk factors associated with endophthalmitis after pars plana vitrectomy

Surgery-related risk factors	Patient-related risk factors
Inadequate wound closure	Diabetes mellitus or other causes of immune compromise
Hypotony	Trauma or excessive eye rubbing
Vitreous incarceration	Noncompliance with treatment
Endotamponade agent (air, gas, or silicone oil)
Subconjunctival and intravitreal injections
Surgeon learning curve (non-beveled sclerotomies)

Table 4 Culture positivity rates in endophthalmitis after pars plana vitrectomy

Reference	Year	Culture positivity rate	Culture-positive cases (n)	Predominant organism
Cohen et al^Citation8	1995	89%	16/18	CNS
Aaberg et al^Citation7	1998	100%	3/3	CNS
Eifrig et al^Citation10	2004	83%	5/6	Staphylococcus aureus
Joondeph et al^Citation11	2005	100%	5/5	CNS
Abi-Ayad et al^Citation40	2007	29%	4/14	CNS
Scott et al^Citation18	2008	100%	1/1	CNS
Shimada et al^Citation19	2008	100%	2/2	MRSA, Enterococcus faecalis
Chen et al^Citation17	2009	50%	1/2	Staphylococcus aureus
Mollan et al^Citation12	2009	0%	–	None
Scott et al^Citation21	2011	50%	2/3	CNS
Mutoh et al^Citation46	2012	0%	–	None

Abbreviations: CNS, coagulase-negative staphylococci; MRSA, methicillin-resistant Staphylococcus aureus.

Table 5 Visual acuity outcomes in reported series of post-pars plana vitrectomy endophthalmitis after treatment

Reference	Diagnosis at time of PPV	Year	Cases (n)	Visual outcome at last visit
Cohen et al^Citation8	ERM, MH, PDR	1995	18/12,216	3 EV, 6 NLP, 1 HM, 1 LP, 2 20/400, 1 20/50, 1 20/30, 1 20/25 and 2 20/20
Aaberg et al^Citation7	–	1998	3/6,557	All eyes NLP
Eifrig et al^Citation10	PDR, macular pucker, recurrent RD	2004	6/15,326	3 NLP, 1 LP, 1 2/200 and 1 20/200
Joondeph et al^Citation11	VH, MH, ERM, RD	2005	5/10,397	2 NLP, 1 HM, 1 20/200 and 1 20/50
Shaikh et al^Citation16	ERM	2007	2/129	One 20/400, one 20/40
Scott et al^Citation18	ERM, PDR, CRVO, disc pit	2008	13/7,682	1 LP, 1 HM, 1 20/400, 1 5/200, 2 20/150, 1 20/100, 2 20/20, 2 20/40, 2 20/30
Shimada et al^Citation19	ERM	2008	2/6,935	Both cases NLP
Chen et al^Citation17	VH, TRD with VH	2009	2/3,477	One 20/200, one 20/125
Mollan et al^Citation12	MH, PDR	2009	2/5,278	One 1/60, one 6/12
Scott et al^Citation21	RD, MH, ERM	2011	3/8,554	One HM, one 20/100, one 20/40
Mutoh et al^Citation46	CME, ERM	2012	4/502	One 20/30, one 20/100, one 20/20, one 20/25

Abbreviations: PPV, pars plana vitrectomy; NLP, no light perception; LP, light perception; HM, hand motion vision; ERM, epiretinal membrane; RD, retinal detachment; VH, vitreous hemorrhage; CRVO, central retinal vein occlusion; PDR, proliferative diabetic retinopathy; CME, cystoid macular edema; MH, macular hole; TRD, traction retinal detachment; EV, eviscerated.

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