ENDOPHTHALMITIS INCIDENCE AFTER VITRECTOMY: A Systematic Review and Meta-Analysis of Risk Factors and Prevention Strategy.

Abstract

Consensus is lacking on best practice to minimize endophthalmitis rates after vitrectomy. This review examines all available literature to determine the incidence of postvitrectomy endophthalmitis and associated risk-reduction strategies. A comprehensive literature search was performed for endophthalmitis incidence after vitrectomy. Meta-analysis was performed comparing risk factors for endophthalmitis: instrument gauge, prophylactic antibiotics, phacovitrectomy, and intraocular tamponade. 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 nonsignificantly higher risk of endophthalmitis compared with 20-gauge surgery (OR 2.09, 95% CI 0.88-5.0). Endophthalmitis rates were significantly higher with 25-gauge compared with 23-gauge instruments (OR 2.03, 95% CI 1.05-3.92). Prophylactic subconjunctival antibiotic use did not decrease the risk of endophthalmitis compared with 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). The use of intraocular tamponade other than fluid was associated with significantly lower rates of endophthalmitis (OR 0.15, 95% CI 0.09-0.27). The incidence of endophthalmitis was higher than in previous reviews. Nonfluid intraocular tamponade significantly reduced the incidence of endophthalmitis but subconjunctival antibiotics did not. Small-gauge vitrectomy and phacovitrectomy were not associated with significantly higher rates of endophthalmitis.