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ENDOPHTHALMITIS AFTER PARS PLANA VITRECTOMY: Efficacy of Intraoperative Subconjunctival Antibiotics

Weiss, Stephanie J., DO*; Adam, Murtaza K., MD; Gao, Xinxiao, MD; Obeid, Anthony, MD; Sivalingam, Arunan, MD; Fineman, Mitchell S., MD; Maguire, Joseph I., MD; Garg, Sunir J., MD; Haller, Julia, MD; Fischer, David H., MD; Hsu, Jason, MD

doi: 10.1097/IAE.0000000000002175
Original Study

Purpose: To examine rates of acute infectious endophthalmitis after pars plana vitrectomy (PPV) in eyes that received intraoperative subconjunctival antibiotics versus eyes that did not.

Methods: A retrospective, nonrandomized, comparative case series of 18,886 consecutive cases of transconjunctival 23-, 25-, and 27-gauge PPV over a 5-year period was performed. The impact of prophylactic intraoperative subconjunctival antibiotics on the development of acute infectious postoperative endophthalmitis was examined.

Results: Of 18,886 cases of PPV, 14,068 (74.5%) received intraoperative subconjunctival antibiotics, whereas 4,818 (25.5%) did not. Sixteen cases (0.085%, 1/1,176) of post-PPV endophthalmitis were identified. The incidence of endophthalmitis in eyes that received subconjunctival antibiotics was 0.078% (11/14,068 cases, 1/1,282), whereas the incidence in those that did not receive subconjunctival antibiotics was 0.10% (5/4,818 cases, 1/1,000). No statistically significant difference was identified in the incidence of endophthalmitis between those that received subconjunctival antibiotics and those that did not (P = 0.598). Microbial culture was performed in 11 cases with 6 culture-positive cases (5/8 cases that received subconjunctival antibiotics and 1/3 cases that did not).

Conclusion: Prophylactic subconjunctival antibiotics were not associated with a significantly reduced rate of post-PPV endophthalmitis. With consideration of emerging multidrug-resistant bacteria, routine prophylactic subconjunctival antibiotics may not be justified.

Endophthalmitis is a rare complication of pars plana vitrectomy, occurring in 0.085% of cases. Routine prophylactic subconjunctival antibiotic injections were not associated with a significantly reduced rate of postoperative endophthalmitis and may not be justified.

*Department of Ophthalmology, Drexel University College of Medicine, Philadelphia, Pennsylvania; and

Mid Atlantic Retina, Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania.

Reprint requests: Jason Hsu, MD, Mid Atlantic Retina, Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107; e-mail:

None of the authors has any financial/conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.