May 12, 2010
Amrita School of Medicine, Kochi
Dr. Tufela Shafi, Vitreo-Retinal Fellow at the Department of Ophthalmology won the best paper award in the recently concluded 61st Delhi Ophthalmic Society Conference at New Delhi. Her paper was titled — Core Vitrectomy versus Near Total Vitrectomy with PVD induction and retinal surface cleaning in the visual outcome of postoperative endophthalmitis.
“Postoperative endophthalmitis is among the most disastrous complications that an ophthalmic surgeon has to face,” stated the paper abstract. “Despite options like intravitreal antibiotics and vitrectomy, the results are variable and the management of the postoperative endophthalmitis still poses a challenge to the practicing ophthalmologist.”
Postoperative endophthalmitis is marked by a severe inflammation in the eye and occurs sometimes after surgery in the eyes.
Postoperative endophthalmitis can be treated. The recommended surgical treatment is core vitrectomy as advocated by the Endophthalmitis Vitrectomy Study, that was published fifteen years ago.
Dr. Tulefa’s paper focused on the advantages of performing near total vitrectomy versus core/limited vitrectomy for the treatment of postoperative endophthalmitis and the need to convert to near total vitrectomy.
In virectomy, some or all of the vitreous humor is removed from the eye. Vitreous humor is the clear gel that fills the space between the lens and the retina of the eyeball.
“Fifteen years ago, vitrectomy systems and techniques were in their infancy,” explained Dr. Tuelfa. “The on-table field of view available at that time was limited and hence a conservative approach was encouraged.”
“But since that time, vitrectomy has seen tremendous progress and newer suture-less techniques and wide-field viewing systems have come into existence. In the fifteen years since the study was published, the procedure of near total vitrectomy has become safe as well as comfortable for patients.”
Reproduced below are excerpts from the abstract of the award-winning paper.
Aims and Objectives
To compare the visual outcome of core vitrectomy and near total vitrectomy in post operative endophthalmitis.
Inclusion Criteria
Endophthalmitis following cataract surgery in patients with visual acuity less than hand movements.
Materials and Methods
24 eyes of 24 patients with postoperative endophthalmitis were randomized equally into 2 groups. Group I eyes were subjected to core vitrectomy while Group II eyes underwent a near total vitrectomy.
Results
Results were analyzed in terms of post operative visual acuity at 1 week, 6 weeks and 12 weeks, post operative media clarity as graded by the EVS classification, number of surgeries required in all and complications, if any. Both postoperative media clarity as well as visual acuity were far superior in the near total vitrectomy. Besides more than 50% patients in the core vitrectomy group had to undergo re-surgery versus none in the near total vitrectomy group. No complications were reported in either group.
Conclusions
In the correct hands, near total vitrectomy is the procedure of choice and VR Surgeons should convert from core vitrectomy to near total vitrectomy and PVD induction in postoperative endophthalmitis for better results.
The study was conducted under the guidance of Dr Gopal S. Pillai, the chief of vitreo-retinal services at Amrita.
