|Year : 1982 | Volume
| Issue : 6 | Page : 631-634
Vitrectomy in endophthalmitis
SRK Malik, RP Sachdev
Dr. S.R.K. Malik 44, Kotla Road, New Dethi, India
44, Kottla Road New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Malik S, Sachdev R P. Vitrectomy in endophthalmitis. Indian J Ophthalmol 1982;30:631-4
Endophthalmitis is the inflammation of inner coat of the eye ball either by bacteria, fungal or parasites. It is a devastatinge complication seen more often in the post operative period and it usually results in the loss of the useful vision. If the eye is to be saved, diagnosis and intensive treatment at the earliest possible time is essential. The incidence of endophthalmitis varies from 0.86% to 3.5% in various series. Many eyes are lost due to secondary glaucoma.
The purpose of this paper is to emphasise the role of vitrectomy in endophthalmitis.
| Materials and methods|| |
The vitrectomy was done in 14 out of 56 cases of endophthalmitis occurring after cataract extraction. [Table - 1]. The patients were seen from 5th to 21st day of the surgery [Table - 2]. A complete ocular examination and systemic examination were conducted in every case. All cases were given medical treatment shown in [Table - 3].
If there was no clinical improvement in 48 hours, a close parsplana vitrectomy was done under local anaesthesia. In many cases the vitrectomy was done if no further improvement took place with the medical treatment [Table - 4], formation of adhesion between iris and anterior phase of the vitreous with tendency towards formation of iris bombe, tendency towards organisation of exudates in the pupillary area and massive exudates
in the vitreous not showing further signs of resolution. Parsplana vitrectomy was done with Peyman Disposable vitreophage alongwith Sukut motor machine. In one case open sky methods was used as corneal wound was already gapping.
| Observations and discussion|| |
Out of 14 cases, 6 were male and 8 were female and their age varied from 50-75 years. All cases were given medical treatment as show in [Table - 3]. Vitrectomy was done after 48 hours in 4 cases which did not show much improvement with medical treatment. In the remaining cases the vitrectomy was done on the 8th day In 4 cases, on 14th (lay in 3 cases, on 21st clay in 2 cases and on 26th day in one case. Fundus examination after vitrectomy showed multiple small round exudates in the vitreous just in front of the blood vessels or alongwith them in 5 cases [Figure - 1][Figure - 2], oedema of the optic disc and macula in 9 cases, patches of grey white area scattered all over the fundi in 10 cases and sheathing of blood vessels in 4 cases. Fundus picture after 3 months showed pollor of the disc and sheathing of blood vessels in 6 cases, formation of pre retinal gliosis in two cases and maculopathy in 4 cases [Figure - 3][Figure - 4] [Table - 5]. With medical treatment and vitrectomy it was possible to save all the eyes even though vision did not improve in 2 cases, visual improvement was less than 6/60 in 4 cases, 6160 in I case, 6/36 in 2 cases, 6/18 in two cases and one case improved to 6/9 [Table - 6]. Non improvement of vision was due to optir atrophy, mocula pathy and pre-retinal gliosis [Table - 7]. One case developed retinal detachment which responded well to surgery. 3 cases developed high tension due to the formation of the adhesions between iris and organised exudates and the vitreous phase responded well to the vitrectomy.
Two cases whose fasting blood sugar were normal were found to be having very high post parandial blood sugar which was detected after the onset of endophthalmiri".
The following recommendations are made 1. Intensive' medical treatment should be given in all cases. If no improvement takes place in 48 hours, vitrectomy should be done.
2. Vitrectomy should be done immediately if there is no further improvement to the medical treatment.
3. Vitrectomy should not be delayed in case when there are formation of adhesions between iris and anterior phase of the vitreous with tendency towards formation of iris bombe, tendency towards organisation of exudates in the pupilliary area and massive exudates in the vitreous not showing further signs of resolution and development of high tension.
4. Every patient of cataract extraction of complaint of the pain in the post operative period should be given a detailed examination with slit lamp and indirect ophthalmoscopy to detect early signs of endophthalmos.
5. The fasting and post parendial blood sugar should be done in each and every case.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6], [Table - 7]