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A Systematic Review and Meta-analysis

Chen, Guohai, MD*; Tzekov, Radouil, MD, PhD†,‡; Li, Wensheng, MD, PhD§; Jiang, Fangzheng, MD*; Mao, Sihong, MD*; Tong, Yuhua, MD*

doi: 10.1097/IAE.0000000000002055
Original Study

Purpose: The purpose of this study was to review the literature reporting rates of postoperative endophthalmitis after pars plana vitrectomy and investigate whether modern microincision vitrectomy surgery (MIVS) increases the postoperative endophthalmitis rate, compared with traditional 20-gauge (20 G) vitrectomy.

Methods: A comprehensive literature search was performed to identify studies describing the incidence of post–pars plana vitrectomy endophthalmitis. A meta-analysis of comparative studies reporting the endophthalmitis rates after MIVS versus 20 G vitrectomy was also conducted.

Results: A total of 31 studies reported 199 endophthalmitis cases in 363,544 participants (0.05%). The incidence of endophthalmitis after 20 G vitrectomy was 0.04% (88/229,435), compared with 0.03% (8/27,326) after 23 G and 0.11% (33/29,676) after 25 G. The meta-analysis demonstrated that the incidence of endophthalmitis was higher after MIVS (23 G/25 G) compared with 20 G vitrectomy (odds ratio = 3.39, 95% confidence interval, 1.39–8.23). In a subgroup analysis, we also found an increased risk of endophthalmitis after 25 G compared with 20 G vitrectomy (odds ratio = 4.09, 95% confidence interval, 2.33–7.18), but not for 23 G versus 20 G (odds ratio = 1.14, 95% confidence interval, 0.47–2.78).

Conclusion: The incidence of post–pars plana vitrectomy endophthalmitis was low, with no significant differences between 23 G MIVS and 20 G vitrectomy, but 25 G MIVS may result in a higher postoperative endophthalmitis rate.

The incidence of endophthalmitis after pars plana vitrectomy during the period 1977–2017 was generally low (<0.2%). A meta-analysis showed that there was no difference between the rate of endophthalmitis after 23-gauge and 20-gauge vitrectomy but that 25-gauge vitrectomy may result in a higher rate of endophthalmitis.

*Department of Ophthalmology, Quzhou People's Hospital, Quzhou, Zhejiang, PR China;

The Roskamp Institute, Sarasota, Florida;

Department of Ophthalmology, University of South Florida, Tampa, Florida; and

§Shanghai Aier Eye Hospital, Shanghai, PR China.

Reprint requests: Wensheng Li, MD, PhD, Shanghai Aier Eye Hospital, 1286 Hongqiao Road, Shanghai, PR China 200336; e-mail:

Supported by the National Natural Science Foundation of China (No. 81570875 to W. Li) and Welfare Technology Applied Research Program Fund of Science Technology Department of Zhejiang Province (No.LGF18H120002 to YHT).

None of the authors has any conflicting interests to disclose.

G. Chen and R. Tzekov authors contributed equally to this work and should be regarded as co-first authors.

© 2019 by Ophthalmic Communications Society, Inc.