Pars plana vitrectomy with primary implantation of silicone oil after treatment of acute exogenous endophthalmitis in eyes without detachment of retina
Abstract
Acute exogenous endophthalmitis (AEE) is the most serious post-traumatic or postoperative complication which without immediate treatment leads to amaurosis or anatomical loss of the eye. If comprehensive antibiotic treatment fails immediate pars plana vitrectomy (PPV) is indicated.
Empirically and later also by laboratory methods the antiinflammatory effect of silicone oil (SO) was revealed. The objective of the present retrospective study is to demonstrate anatomical and functional results of PPV with implantation of SO for AEE on eyes without detachment of the retina.
In 1990-2000 the authors operated a total of 22 eyes of 22 patients with AEE. The mean age of the patients was 59.6 years, the mean observation period 35.5 months.
In 17 eyes postoperative and in 5 eyes post-traumatic AEE was involved. The mean interval between the original operation and PPV was 20.8 days and between the injury and PPV 5.4 days.
In all patients we took at the beginning of PPV specimens of the vitreous body for cultivatin which gave in 63.6% a positive result. The intraocular lens was explanted in 81.8 % eyes.
After subtotal resection of the vitreous body we implanted SO and in all aphakic eyes we performed iridectomy in no.6. PPV was completed by administration of vancomycin and ceftazidime into the vitreous space.
In 95.4% of the eyes we preserved anatomically the bulbus, in one instance we eviscerated the bulbus three days after failure of PPV (4.6%). In 86.4 % the retina remained anatomically attached and in the remaining 9% eyes beneath the SO traction detachment of the retina developed.
Visual acuity improved in 72.7 % eyes, it remained unchanged in 9.1 % eyes and deteriorated in 18.2 % eyes. Silicone oil was explanted in 40.9 % eyes after a mean interval of 4.6 months following PPV.
In the remaining patients we did not indicate explantation of SO, in particular because of the patients' advanced age, Conclusion: we recommend PPV and implantation of SO in AEE on eyes without detachment of the retina as the method of choice.