Surgery for eye infections

Endophthalmitis is a sight-threatening intraocular inflammatory disorder resulting from infection of the vitreous cavity. Following introduction of pars plana vitrectomy (PPV), the role of this treatment modality for endophthalmitis was controversial. Our laboratory is studying whether new surgical instrumentation is effective for treating this condition.

The surgical management of endophthalmitis has generated increasing interest in recent decades, particularly after the Endophthalmitis Vitrectomy Study (EVS). PPV is believed to help in the treatment of endophthalmitis by removal of infecting organisms and toxins, removal of vitreous membranes that could otherwise lead to retinal detachment, clearing of vitreous opacities, allowing better penetration of injected antibiotics, and collection of adequate vitreous material for culture.

Since the EVS, recent advancements in microsurgical instrumentation have led to the increased use of smaller, 23- and 25-gauge, instrumentation for pars plana vitrectomy (PPV).3-5 In contrast to 20-gauge sclerotomies, smaller-gauge sclerotomies are created without conjunctival dissection, utilize a cannula, and are typically left unsutured. These small gauge wounds offer the potential advantages of reduced operative time, decreased surgical trauma, reduced post-operative astigmatism, and more rapid post-operative visual recovery. Furthermore, both the 23- and 25-gauge instrumentation are now used in a variety of vitreoretinal procedures. Smaller gauge surgical instrumentation may be adequate for vitreous biopsies and management of endophthalmitis, but this has not been systematically studied.