title: [Endoscopy-guided 20-G vitrectomy in severe endophthalmitis: Report of 18 cases and literature review].
abstract: OBJECTIVE
  To report the anatomical and functional outcomes after endoscopy-guided vitrectomy in a series of cases of severe endophthalmitis. Also to identify and compare the outcomes of two different modes of clinical presentation.
  
  
  METHODS
  Retrospective case study, single center; all patients who underwent endoscopic 20Ga vitrectomy (Endo optiks E4 system) for severe endophthalmitis were included. For each case, data were recorded for: etiology, surgical indication, preoperative and postoperative visual acuity, comorbidity factors and postoperative complications, and whether any additional surgery was performed. Two groups were distinguished according to their initial mode of presentation; results were then compared in terms of complications and visual prognosis to those found in the literature.
  
  
  RESULTS
  Eighteen patients were included, with mean age 62±19years. Severe endophthalmitis was initially obvious for 8 cases (group 1). For 10 cases, disease progression had been considered unfavorable despite adequate medical treatment (group 2). There was no statistically significant difference between the two groups (P=0.55). Endophthalmitis occurred: after intravitreal injections (4 cases), after intraocular foreign body (n=2), after cataract surgery (n=5), following a trabeculectomy (n=2), after epiretinal membrane peeling (n=3), 1 case caused by a corneal infection and 1 case of endogenous leptospirosis. Mean follow-up was 13.7months. The surgical technique was a complete 20Ga vitrectomy under endoscopic visual control. The mean operative time was 70±27minutes. The causative organism was identified in 72% of cases in vitreous humor samples, among which 77% were gram-positive organisms. The infection was controlled in 89% of cases, and these patients have recovered useful visual acuity.
  
  
  CONCLUSIONS
  The value of endoscopic visualization in ophthalmology has been proven for 30 S. aureus years, but its miniaturization enhances the current enthusiasm for the use of this instrumentation. When visualization is compromised, endoscopic guided vitrectomy is very useful and may assist the surgeon in the management of these difficult cases. Our anatomical and functional outcomes are encouraging, but we must keep in mind the poor long-term prognosis of severe endophthalmitis.
authors.affiliation: Service d'ophtalmologie, hôpital Morvan, CHRU de Brest, 2, avenue Foch, 29200 Brest, France; Unité Inserm UMR 1101, laboratoire de traitement de l'information médicale (LaTIM), CHRU Morvan, 2, avenue Foch, 29200 Brest, France. Electronic address: martiano.d@gmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Martiano
authors.affiliation: Service d'ophtalmologie, hôpital Morvan, CHRU de Brest, 2, avenue Foch, 29200 Brest, France.
authors.forename: G
authors.initials: G
authors.lastname: L'helgoualc'h
authors.affiliation: Service d'ophtalmologie, hôpital Morvan, CHRU de Brest, 2, avenue Foch, 29200 Brest, France; Unité Inserm UMR 1101, laboratoire de traitement de l'information médicale (LaTIM), CHRU Morvan, 2, avenue Foch, 29200 Brest, France.
authors.forename: B
authors.initials: B
authors.lastname: Cochener
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy; D048909:Diabetes Complications; D009877:Endophthalmitis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D019773:Epiretinal Membrane / Q000601:surgery; D005129:Eye Foreign Bodies / Q000150:complications; D015818:Eye Infections, Bacterial / Q000150:complications; D005260:Female; D006801:Humans; D058449:Intravitreal Injections / Q000009:adverse effects; D008028:Light Coagulation; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D063189:Symptom Assessment; D014130:Trabeculectomy / Q000009:adverse effects; D016896:Treatment Outcome; D014821:Vitrectomy / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Endophtalmie; Endophthalmitis; Endoscopie; Endoscopy; Eye infection; Infection oculaire; Retina; Rétine; Vitrectomie; Vitrectomy; Vitreous; Vitré