Effect of Internal Limiting Membrane Peeling in Visual Outcome of Endophthalmitis after Pars Plana Vitrectomy

You Hyun Lee; Yu Cheol Kim

doi:10.3341/jkos.2015.56.2.213

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Lee and Kim: Effect of Internal Limiting Membrane Peeling in Visual Outcome of Endophthalmitis after Pars Plana Vitrectomy

Original Article

J Korean Ophthalmol Soc 2015;56(2):213-218.

Published online: 6 September 2015

DOI: https://doi.org/10.3341/jkos.2015.56.2.213

Effect of Internal Limiting Membrane Peeling in Visual Outcome of Endophthalmitis after Pars Plana Vitrectomy

You Hyun Lee, MD, Yu Cheol Kim, MD, PhD

Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea

Address reprint requests to Yu Cheol Kim, MD, PhD, Department of Ophthalmology, Keimyung University Dongsan Medical Center, #56 Dalseong-ro, Jung-gu, Daegu 700-712, Korea, Tel: 82-53-250-8026, Fax: 82-53-250-7705 E-mail: eyedr@dsmc.or.kr

Received 5 June 201428 August 2014 Accepted 15 January 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the clinical course and prognostic factors of visual acuity in post-vitrectomy endophthalmitis.

Methods

A total of 9 patients diagnosed with post-vitrectomy endophthalmitis between 2004 and 2013 were enrolled in this ret-rospective study. To evaluate factors affecting final visual acuity, the following was investigated: best corrected visual acuity (BCVA) before first vitrectomy, BCVA at presentation, presence of diabetes mellitus, type of port used on first pars plana vi-trectomy, whether cataract operation was performed simultaneously, whether removal of internal limiting membrane was performed at first pars plana vitrectomy, interval period from initial vitrectomy to treatment of endophthalmitis, presence of hypo-pyon, whether culture was proven, and type of organism isolated.

Results

All 9 eyes received intravitreal antibiotic injections and additional pars plana vitrectomy was performed in 7 eyes. Six eyes were culture-proven. Staphylococcus epidermidis was cultured from 5 eyes and Escherichia coli was cultured from 1 eye. BCVA before first vitrectomy, presence of diabetes mellitus, type of port used on first pars plana vitrectomy, whether cataract operation was performed simultaneously, interval from initial vitrectomy to treatment of endophthalmitis, whether culture proven, and type of organism isolated did not affect final visual acuity. BCVA at presentation was an important factor for final visual acuity. Removal of internal limiting membrane at initial vitrectomy was a poor prognostic factor in final visual acuity (p = 0.02).

Conclusions

Endophthalmitis after pars plana vitrectomy showed very poor final visual acuity and better BCVA at presentation resulted in better final visual acuity. Poor visual acuity was observed in patients who had the internal limiting membrane removed at first vitrectomy.

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Keywords: Endophthalmitis, Pars plana vitrectomy, Visual acuity

References

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Table 1.

Clinical characteristics of patients with postvitrectomy endophthalmitis

Patient No.	Gauge	Eye	Age (years)	Sex	Preoperative diagnosis	ILM peeling	BCVA before first vitrectomy	BCVA at presentation	Final VA
1	20	OS	84	M	Epiretinal membrane	Yes	0.08	Hand motion	Hand motion
2	20	OS	53	M	Subretinal hemorrhage	No	0.06	Hand motion	8/100
3	23	OS	78	F	Epiretinal membrane	Yes	0.25	Light perception	Light perception
4	23	OD	79	M	PDR	Yes	0.25	Hand motion	Hand motion
5	23	OS	75	F	Vitreous hemorrhage	No	0.08	Hand motion	4/100
6	20	OD	56	M	PDR	Yes	0.02	Hand motion	Hand motion
7	23	OS	78	F	IOL dislocation	No	0.5	FC 10 cm	Hand motion
8	23	OS	77	F	PDR	No	0.2	10/100	20/100
9	23	OD	72	M	Refractory ME	Yes	0.06	NLP	NLP

ILM = internal limiting membrane; BCVA = best corrected visual acuity; VA = visual acuity; PDR = proliferative diabetic retinopathy; IOL = intraocular lens; ME = macular edema; FC = finger count; NLP = non light perception.

Table 2.

Comparison between best corrected visual acuity before the first vitrectomy and best corrected visual acuity at presentation

Visual acuity before the first vitrectomy	Best corrected visual acuity at presentation				Total	r^∗	p-value
Visual acuity before the first vitrectomy	≤ LP	HM-FC 30 cm	2/100-16/100	≥20/100	Total	r^∗	p-value
≤ LP	0	0	0	0	0	0.155	0.35
HM-FC 30 cm	0	0	0	0	0
2/100-16/100	1	4	0	0	5
≥20/100	1	2	1	0	4
Total	2	6	1	0	9

LP = light perception; HM = hand motion; FC = finger count.

^∗ Spearman’s correlation coefficient.

Table 3.

Comparison between best corrected visual acuity before the first vitrectomy and final visual acuity

Visual acuity before the first vitrectomy	Final visual acuity				Total	r^∗	p-value
Visual acuity before the first vitrectomy	≤ LP	HM-FC 30 cm	2/100-16/100	≥20/100	Total	r^∗	p-value
≤ LP	0	0	0	0	0	-0.046	0.45
HM-FC 30 cm	0	0	0	0	0
2/100-16/100	1	2	2	0	5
≥20/100	1	2	0	1	4
Total	2	4	2	1	9

LP = light perception; HM = hand motion; FC = finger count.

^∗ Spearman’s correlation coefficient.

Table 4.

Comparison between best corrected visual acuity at presentation and final visual acuity

Visual acuity at presentation	Final visual acuity				Total	r^∗	p-value
Visual acuity at presentation	≤ LP	HM-FC 30 cm	2/100-16/100	≥20/100	Total	r^∗	p-value
≤ LP	2	0	0	0	2	0.882	0.02
HM-FC 30 cm	0	4	2	0	6
2/100-16/100	0	0	0	1	1
≥20/100	0	0	0	0	0
Total	2	4	2	1	9

LP = light perception; HM = hand motion; FC = finger count.

^∗ Spearman’s correlation coefficient.

Table 5.

Final visual acuity related to the given valuables

	Final visual acuity		Total	p-value^∗
	≤ HM	≥ FC	Total	p-value^∗
Prsence of DM
DM (+)	4	2	6	0.774
DM (-)	2	1	3
Kind of port used in vitrectomy
20 gauge	2	1	3	0.762
23 guage	4	2	6
Whether cataract operation went simultaneously
PPV only	5	3	8	0.667
PPV + Cat	1	0	1
Internal limiting membrane peeling
ILM peeling (+)	5	0	5	0.048
ILM peeling (-)	1	3	4
Presence of hypopyon
Hypopyon (+)	4	2	6	0.774
Hypopyon (-)	2	1	3
Culture status
Culture positive	5	1	6	0.226
Culture negative	1	2	3
Type of organism in culture proven group
Gram (+)	4	1	5	0.833
Gram (－)	1	0	1
Duration between first vitrectomy and treatment of postoperative endophthalmitis
Within 3 days	3	2	5	0.595
After 4 days	3	1	4

HM = hand motion; FC = finger count; DM = diabetes mellitus; PPV = pars plana vitrectomy; Cat = cataract operation; ILM = internal limiting membrane.

^∗ Pearson chisquare test.

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