Endophthalmitis after Pars Plana Vitrectomy

Abstract

Objective

Endophthalmitis is a rare but devastating complication of pars plana vitrectomy (PPV). We assessed the incidence, profile, and prognostic factors of post-PPV exogenous endophthalmitis in a large ethnically diverse cohort over an 11-year period.

Design

A retrospective single-site cohort study.

Participants

Adult patients (aged ≥18 years) undergoing PPV at Moorfields Eye Hospital.

Methods

Pars plana vitrectomy procedures between January 1, 2013 and January 1, 2024 were extracted from the electronic health record and cross-referenced with all endophthalmitis cases using clinical documentation, prescription records, and incident reports.

Main Outcome Measures

The incidence proportion was estimated and stratified by additional procedures during PPV. Odds ratios (ORs) with 95% confidence intervals (CIs) for the association between endophthalmitis and exposures were estimated using univariable and multivariable logistic regression models.

Results

There were 36  179 procedures from 26  533 patients included in the analysis. The overall incidence of post-PPV endophthalmitis was 0.05% (n = 19), of which 63.2% (n = 12) were culture positive. Five cases occurred after 28 days, of which 3 had coexisting anterior segment pathology including corneal abscesses and loose sutures. Incidence figures varied from 0.05% in PPV with internal limiting membrane peel to 0.65% in those undergoing intraocular lens (IOL) exchange. Higher odds of endophthalmitis were seen with fluid tamponade (adjusted OR [aOR], 5.70; 95% CI, 1.80–18.03; P = 0.003) and increasingly complex secondary IOL procedures—secondary IOL insertion alone (aOR, 5.42; 95% CI, 1.23–23.97; P = 0.026); IOL removal (aOR, 9.81; 95% CI, 3.10–31.07; P = 1.0 × 10⁻⁴); and IOL exchange (aOR, 13.64; 95% CI, 4.29–43.43; P = 9.7 × 10⁻⁶). When adjusting for tamponade, IOL removal (aOR, 4.64; 95% CI, 1.14–18.86; P = 0.032) and IOL exchange (aOR, 6.24; 95% CI, 1.43–27.27; P = 0.015) remained significantly associated with endophthalmitis. Endophthalmitis associated with secondary IOL procedures were all culture positive (n = 3 Staphylococcus spp, n = 3 Streptococcus spp).

Conclusions

Although post-PPV exogenous endophthalmitis is rare, individuals undergoing PPV with IOL removal and exchange have considerably increased odds of developing endophthalmitis. Delayed cases of endophthalmitis frequently have coexisting anterior segment pathology.

Financial Disclosure(s)

Proprietary or commercial disclosures may be found in the Footnotes and Disclosures at the end of this article.