Incidence of post vitrectomy endophthalmitis in India - A multicentric study by VRSI study Group

Abstract

Introduction: The incidence of post vitrectomy endophthalmitis (PVE) is reported to be between 0.02 and 0.84%. Resterilization of single use instruments is a common practice amidst developing countries to make it more affordable to the patients by reducing the cost of the surgery and also reduce the environmental hazard. The aim of our study is to evaluate the incidence of PVE amidst existing sterilization practices of reused instruments in multiple vitreoretinal centres in India.

Methodology: Centres with an endophthalmitis tracking system were invited to participate in a survey. Twenty-five centres were sent a questionnaire via email. The questionnaire included details about the institution, number of vitrectomies performed in a year, sterilization practices followed pre-operatively, intraoperatively and postoperatively, incidence of endophthalmitis and instrument reuse policies.

Results: A total of 29 cases of endophthalmitis were reported out of the 47,612 vitrectomies performed across various centres. The mean incidence of endophthalmitis was 0.06%. There was no difference in the rates of endophthalmitis based on various pre-operative, intraoperative or postoperative prophylactic measures. Nearly 80% of the centres change most of the instruments after every case, while the rest reused. The mean number of times a cutter was being reused until discarded was 4.7. Nearly 76% followed a performance-based protocol, and the remaining 24% had a fixed protocol for the number of times an instrument can be reused before discarding it.

Conclusion: PVE rates are not significantly different in India despite the multiuse of single use instruments. The purpose of this paper is not to suggest an alternate protocol but to creating one in the future with these results in mind, to rationalise the use of single use instruments, make VR surgery more affordable and also have a positive impact on the carbon footprint of consumables in surgery.

Fig. 1. Graphs depicting rate of endophthalmitis.

A The scatterplot above depicts the correlation between number of vitrectomies performed in a year and number of endophthalmitis per 1000 vitrectomies. The blue line represents the correlation trend and grey area shows 95% confidence interval. B The Box-and-Whisker plot above depicts the distribution of endophthalmitis cases amidst vitrectomy surgeries in the 3 groups of chemical sterilisation of instruments with lumen. C The Box-and-Whisker plot above depicts the distribution of endophthalmitis cases amidst vitrectomy surgeries amidst cassette reuse.