Pars plana vitrectomy with silicone oil versus pars plana vitrectomy alone for postoperative endophthalmitis: A randomized controlled trial.
Ehab Mohamed Elsayed Saad, Hazem Elbadry Mohammed Mohammed, Ehab Tharwat et al.
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In 30 seconds
This prospective randomized controlled trial compared pars plana vitrectomy (PPV) with 1000-cSt silicone oil (SO) tamponade against PPV alone in 40 eyes with severe post-phacoemulsification endophthalmitis unresponsive to initial intravitreal antibiotics. At 12 weeks, visual acuity improved numerically more with SO, but the difference was not statistically significant (1.5 ± 0.3 vs. 1.7 ± 0.4 logMAR; P = 0.289). Infection recurrence was lower with SO: two eyes (10%) versus eight (40%) with PPV alone (P = 0.021).
Key findings
- Recurrence occurred in two eyes (10%) with SO versus eight eyes (40%) with PPV alone (P = 0.021).
- Final BCVA was 1.5 ± 0.3 logMAR with SO and 1.7 ± 0.4 logMAR with PPV alone; the difference was not statistically significant (P = 0.289).
- At 8 weeks, IL-6 was 142 pg/mL vs. 298 pg/mL (P = 0.018), and IL-8 was 84 pg/mL vs. 176 pg/mL (P = 0.024), with SO versus PPV alone.
- In multivariate regression, recurrence (β = 0.31, P = 0.009) and 8-week IL-6 (β = 0.001, P = 0.003) independently predicted worse visual outcomes.
Why it matters
In this trial of severe postoperative endophthalmitis, SO tamponade was associated with fewer recurrences and lower measured intraocular cytokine levels, while a significant visual-acuity advantage was not demonstrated. These findings help distinguish infection and inflammation outcomes from visual outcomes when assessing the potential role of tamponade in this setting.
What to keep in mind
The trial included 40 eyes, and follow-up for the primary visual outcome was 12 weeks; the visual-acuity difference was not statistically significant.