Characteristics and Risks of Endophthalmitis after 25-gauge Vitrectomy Surgery over a 14-year Period.

Purpose: To analyze endophthalmitis characteristics and risks after a 25-gauge vitrectomy or microincision vitrectomy surgery (MIVS).
Design: Retrospective.
Subjects: Post-MIVS endophthalmitis patients.
Methods: The records of a private, retina practice and an ambulatory surgery center (ASC) were searched from January 2010 to April 2024, for post-MIVS endophthalmitis cases. Data collected were age, sex, surgeon, first assistant, procedure, surgery date, surgical platform, symptom onset date, preoperative visual acuity (VA), infection presentation VA, 90-day postoperative VA, case length, vitreous substitute (balanced salt solution [BSS], gas, air, or oil), sclerotomy suture use, surgical complications, vitreous sampling culture growth, and endophthalmitis treatment. Logarithm of the minimum angle of resolution-converted VAs were analyzed from preoperative to 90-day postoperative endophthalmitis. The procedures included pars plana vitrectomy (PPV) for macular pucker, vitreous opacity or hemorrhage, with endolaser, for retinal detachment (RD), and macular hole (MH). An all MIVS cohort to analyze patient sex, surgeon caseload, platforms, and procedure was created for incidence and statistical calculations. A secondary comparison, April to May 2023, was performed analyzing endophthalmitis per vitreous substitute via chi-square test for independence.
Main Outcome Measures: Endophthalmitis post-MIVS.
Results: The ASC saw 27 of 24 987 (0.11%) post-MIVS endophthalmitis cases. None of the surgeries recorded intraoperative complications. The average time between surgery and presentation was 2.88 ± 2.66 days. Mean VA preoperatively and 90-day postoperatively were calculated, 0.630 ± 0.717 and 1.041 ± 0.895, respectively (0.286 ± 0.437 mean difference). The individual surgeon incidence of endophthalmitis was not found to be significant in this study. Endophthalmitis incidence per PPV is 13 of 5545 (0.23%) postmacular pucker, 7 of 4619 (0.15%) vitreous opacity or hemorrhage, 4 of 2350 (0.17%) endolaser, 3 of 9834 (0.03%) RD, and 0 (0.0%) MH (P = 0.0004). Of 435 PPVs performed April to May 2023, vitreous substitutes were 183 (42%) gas-filled, 169 (38.9%) BSS-filled, 45 (10.3%) oil-filled, and 38 (8.7%) air-filled. Of the 27 endophthalmitis cases, 23 (85.2%) used BSS, 1 (3.7%) oil-filled, and 2 (7.4%) air-filled. A significant statistical association between vitreous substitute and endophthalmitis incidence via chi-square testing (P < 0.0001) was found.
Conclusions: This study found a 1 of 910 (0.11%) incidence of endophthalmitis post-25-gauge MIVS. Both vitreous substitute and procedure type showed a significant risk of endophthalmitis. Although endophthalmitis risk is low overall, the potential for severe vision loss warrants further examination into contributing characteristics and risks.
Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
(Copyright © 2025. Published by Elsevier Inc.)