Incidence, Causes, and Management of Post Vitrectomy Endophthalmitis: A Metaanalysis Study

Background Endophthalmitis is a rare but severe form of ocular inflammation due to infection of the intraocular cavity that can lead to irreversible visual loss if not treated properly and timely. Clinical features of endophthalmitis following PPV (Pars Plana Vitrectomy) are similar to those of endophthalmitis following cataract surgery. Some cases, however, may demonstrate a delayed presentation. Objective To do a meta-analysis of studies to know the incidence, causes, and management of post vitrectomy endophthalmitis. Patients and Methods The current review followed the guidelines of preferred reporting items for systematic reviews and meta-analysis) statement 2009 PRISMA (Preferred Reporting Itims for Systematic Reviews and Meta analysis). Results Electronic search yielded 306 articles from two databases. After duplicates removal, 102 articles were screened in title/abstract screening, while 33 articles were screened in full text screening for inclusion. Finally, 18 articles were included in qualitative and quantitative meta-analysis. The manual search resulted in no additional studies. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021. Data Extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Conclusion The overall incidence of post-PPV endophthalmitis across all studies was low. More recent data indicate that using 25 gauge needle during vitrectomy was significantly has the highest endophthalmitis incidence rate than others. While using 20 gauge needle during vitrectomy was significantly has the lowest endophthalmitis incidence rate than others. Vitreoretinal surgeons need to pay close attention especially when performing 25 G PPV, including a meticulous sclerotomy preparation, balancing the potential benefits of nonfluid tamponade, and removing all vitreous wicks, to reduce the risk of endophthalmitis.