Occurrence and risk factors for retinal detachment after pars plana vitrectomy in acute postcataract bacterial endophthalmitis
2016
Chiquet, Christophe | Aptel, Florent | Combey-de Lambert, Aurélie | Bron, Alain | Campolmi, Nelly | Palombi, Karine | Thuret, Gilles | Rouberol, Frédéric | Cornut, Pierre-Loïc | Creuzot-Garcher, Catherine | Université Grenoble Alpes [2016-2019] (UGA [2016-2019]) | Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon) | Centre des Sciences du Goût et de l'Alimentation [Dijon] (CSGA) ; Institut National de la Recherche Agronomique (INRA)-Université de Bourgogne (UB)-Centre National de la Recherche Scientifique (CNRS) | Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E) | Hôpital Edouard Herriot [CHU - HCL] ; Hospices Civils de Lyon (HCL) | Health Ministry (PHRC, French public programme of clinical research), AFAU (French association of unilateral amblyopia), ARFO (association for research and learning in ophthalmology) and the Laboratoires Thea.
[b]Background/aims[/b]To report the incidence, risk factors and prognosis of retinal detachment (RD) in patients who had vitrectomy for acute bacterial endophthalmitis after cataract surgery.[b]Methods[/b]123 patients with acute postcataract endophthalmitis, consecutively treated with pars plana vitrectomy (PPV) were included by the French Institutional Endophthalmitis Study group, in a prospective multicentre cohort study. Risk factors of RD were analysed using logistic regression.[b]Results[/b]At the 6-month follow-up, the rate of post-PPV RD was 13% (n=16). The risk factors of post-PPV RD were diabetes (OR=4.7 (1.4-15.4), p=0.01) and visualisation of retinal vasculitis on the posterior pole (OR=3.8 (1.1-13.9), p=0.03) at the time of PPV. Postoperative RD occurred in 56% (n=9) of cases in the first month, in 31% (n=5) in the second month and in 6% (n=1) in the third month, with a mean delay of 4771days after PPV. The macula was detached in 12 cases (75%) and proliferative vitreoretinopathy grade C was present in seven cases. Final successful reattachment of the retina was obtained in 60% (n=9/15) of cases, with one (7/9) or two surgeries (2/9). Final visual acuity after surgical repair was 20/40 in 19% of cases, compared with 43% in patients without RD (p=0.05). [b]Conclusions[/b]RD is a major and severe complication of PPV performed in patients with acute postcataract endophthalmitis. Retinal vasculitis is a major risk factor of RD after PPV. Anatomical and functional outcome remain poor.
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