Vitrectomy and silicone oil in the treatment of acute endophthalmitis. Preliminary results

Abstract

Purpose: To evaluate the role of pars plana vitrectomy (PPV) and silicone oil injection in the treatment strategy of severe endophthalmitis.

Patients and methods: This study analyses a retrospective case series of 34 patients with signs and symptoms of severe endophthalmitis with visual acuity limited to light perception. All underwent PPV with intraocular injection of antibiotics (IOAB), together with topical and oral antibiotics. In 10 patients (group 1), this treatment alone was sufficient to control infection. In 10 other patients (group 2) with the same initial treatment, a new vitrectomy was needed: 8 because of retinal detachment, 2 because of persistent infection. In 2 patients (group 3), initially treated with PPV and IOAB, a second vitrectomy with IOAB and silicone oil tamponade was needed to stop infection. In 12 patients (group 4), with the worse prognosis related to the severity of infection and/or to associated retinal necrosis, PPV, IOAB and silicone oil tamponade were conducted at first surgery. Final anatomic status and visual acuity were assessed to compare the effectiveness of these different treatments.

Results: In 22 patients (group 1, 2 and 3) treated initially without silicone oil, 12 patients (55%) needed further surgery, either for persistent infection or retinal detachment. Twelve patients (group 4) treated at first with silicone oil had a rapid control of the infectious process and better anatomical results with this procedure only. Final visual acuity was also better in the silicone oil groups (group 3 and 4) than in the non silicone groups (group 1 and 2).

Conclusion: These results suggest that silicone oil tamponade might be beneficial in the treatment strategy of severe endophthalmitis.