Comparison of Postoperative Complications of Pars Plana Vitrectomy with and without Silicone Oil in Treatment of Acute Endophthalmitis
Abstract
Acute postoperative endophthalmitis is the most common form of endophthalmitis. Pars Plana Vitrectomy (PPV) is one of technique to manage endophthalmitis. Nowadays some additives are used to this technique. This study was conducted to compare postoperative complications of Pars Plana Vitrectomy (PPV) with and without Silicone oil endotamponade in treatment of acute endophthalmitis. Single prospective interventional study was conducted in upgraded department of ophthalmology, SMS Hospital Jaipur. It included 84 patients of acute endophthalmitis equally divided into two groups i.e. Pars Plana Vitrectomy Alone (PPV group) alone and Pars Plana Vitrectomy with silicone oil endotamponade (PPV+SOI group). Results were assess in the form of proportion of postoperative complications. It was observed that postoperative complications were significantly (p=0.007) more in Pars Plana Vitrectomy (PPV) alone (33.33%) than with Pars Plana Vitrectomy with silicone oil endotamponade (7.14%) group. Retinal Detachment was found in 14.29% in PPV alone group which was significantly more (P=0.034) from other group as no retinal detachment found in PPV+SOI group. No significant difference was observed in other complications in both groups. It was concluded that Pars Plana Vitrectomy with silicone oil endotamponade have significantly lesser postoperative complications than PPV alone.
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Introduction
Infectious endophthalmitis is one of the most serious complications of intraocular surgery and has a very poor prognosis if left untreated.1,2 Endophthalmitis is defined as a purulent inflammation of intraocular fluids vitreous and aqueous usually due to infection.3 Acute postoperative endophthalmitis is the most common form of endophthalmitis.
Highest risk of endophthalmitis is after secondary IOL (0.2-0.367%) and lowest after Pars Plana Vitrectomy (0.03-0.046%). Vitreous acts as a culture medium for micro-organisms, and hence after Pars Plana Vitrectomy, the rates of endophthalmitis is least.4,5 The incidence of endophthalmitis after cataract surgery varies according to the surgical technique. But in recent large series, it has ranged from 0.02% to 0.09%.6-8
Endogenous endophthalmitis results from the introduction of organisms into the posterior segment of the eye as a result of hematogenous spread from a remote primary site of infection. Endogenous bacterial endophthalmitisis accounting for only 2 to 8% of all infectious endophthalmitis cases.9
Conclusion
This present study concluded that Pars Plana Vitrectomy with silicone oil endotamponade group have significantly lower rate of postoperative complications than Pars Plana Vitrectomy alone.