Post-Vitrectomy Endophthalmitis in Victoria, Australia

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To the Editor: We congratulate Dave et al1 on their article discussing infectious endophthalmitis after pars plana vitrectomy (PPV). We wish to complement their paper with our experience in Victoria, Australia. Victoria is the most densely populated state in Australia, with a population of approximately 6.0 million. The Royal Victorian Eye & Ear Hospital, Melbourne, Australia, is the largest public vitreoretinal unit in the state. Cases with endophthalmitis admitted to our unit are prospectively databased. We analyzed postvitrectomy endophthalmitis (PVE) presenting between 1997 and 2012, with 20 cases identified over this period. It is estimated that 27,800 PPV operations (Medicare data) were performed during this period in the state of Victoria. This suggests an incidence in Victoria of 0.07%, which compares equally to that described by Dave et al in South India. Eleven of our cases had PPV for rhegmatogenous retinal detachment. Other PPV procedures were undertaken for vitreous hemorrhage, tractional retinal detachment, and macular surgery. All cases of suspected endophthalmitis were managed in a similar institutional protocol that included microscopy and culture of aqueous and vitreous samples. Intravitreal therapy, topical, and systemic treatment were similar to Dave et al. Nine (45%) of our cases did not grow organisms on culturing,which is in keeping with Dave et al1 and a national survey from the United Kingdom.2 The remainder included 6 cases of Staphylococcus species (5 coagulase negative), 3 cases of Streptococcus species, 1 sample of Bacillus, and 1 mixed growth of Streptococcus and Enterococcus. The visual outcome varied from perception of light to 0.1 log-MAR (6/7.5 Snellen equivalent). There was a marked increase in cases F1 of PVE in 2009 to 2010 (Fig. 1), which followed similar patterns in other units.3 This coincided with our uptake of small gauge (G) vitrectomy surgery and continued until 2012. It is our belief that subsequent improvements in trocar manipulation and the move to 25G PPV reduced the effects of vitreous wick and leakage, respectively, and thus the rate of PVE. It is very interesting that Dave et al demonstrate that sutureless surgery and the use of Ringer lactate as endotamponade are significant. Our clinical experience would agree with this.FIGURE 1.: Number of cases of post-vitrectomy endophthalmitis against year. The red arrow indicates the introduction of small gauge pars plana vitrectomy.In conclusion, we have a similar experience of PVE that is rare with poor visual outcomes. These data were presented at Euretina (2014) in London, UK. Aman Chandra FRCOphth, PhD, FRCS Jonathan Smith MRCP, FRCOphth Bob Z. Wang BMBS Emil Kurniawan MBBS, MMed Jonathan Kam MBBS, BMedSc Sukhpal Singh Sandhu MD, FRCOphth Penelope J. Allen FRANZCO From the Department of Ophthalmology Southend University Hospital Prittlewell Chase, Southend on Sea Essex, SS00RY United Kingdom

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