ENDOPHTHALMITIS INCIDENCE AFTER VITRECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RISK FACTORS AND PREVENTION STRATEGY

Vollständiger Abstract

Worum geht es in dieser Arbeit?

Purpose: Consensus is lacking on best practice to minimise endophthalmitis rates following vitrectomy. This review examines all available literature to determine the incidence of post-vitrectomy endophthalmitis and associated risk-reduction strategies. Methods: A comprehensive literature search was performed for endophthalmitis incidence after vitrectomy. Meta-analysis was performed comparing risk factors for endophthalmitis: instrument gauge, prophylactic antibiotics, phaco-vitrectomy, and intraocular tamponade. Results: We identified 69 studies which reported 2,781 cases of endophthalmitis after 1,979,160 vitrectomies (0.14%). Meta-analysis found that smaller-gauge vitrectomy had a non-significantly higher risk of endophthalmitis compared to 20-gauge surgery (OR 2.09, 95%CI 0.88–5.0). Endophthalmitis rates were significantly higher with 25-gauge compared to 23-gauge instruments (OR 2.03, 95%CI 1.05–3.92). Prophylactic subconjunctival antibiotic use did not decrease the risk of endophthalmitis compared to topical antibiotics (OR 0.77, 95%CI 0.36–1.64). Phaco-vitrectomy did not increase the endophthalmitis risk (OR 1.17, 95%CI 0.81–1.70). Use of intraocular tamponade other than fluid was associated with significantly lower rates of endophthalmitis (OR 0.15, 95%CI 0.09–0.27). Conclusion: The incidence of endophthalmitis was higher than in previous reviews. Non-fluid intraocular tamponade significantly reduced the incidence of endophthalmitis but subconjunctival antibiotics did not. Small-gauge vitrectomy and phaco-vitrectomy were not associated with significantly higher rates of endophthalmitis.