Modified-dropless protocol (nil intraocular) for micro-incision vitrectomy surgery (MIVS): a retrospective pilot study

• Published in: BMC ophthalmology Vol. 23; no. 1; p. 195
• Main Authors: Garcia-O'Farrill, Noraliz, Brown, Gordon T, Hunter, Allan A
• Format: Journal Article
• Language: English
• Published: England BioMed Central 04.05.2023; BMC
• Subjects: Acuity; Antibiotics; Cataracts; Cefazolin; Complications; Dexamethasone; Dropless MIVS; Endophthalmitis; Endophthalmitis - etiology; Endophthalmitis - prevention & control; Eye; Eye Diseases; Eye surgery; Fornix; Humans; Infections; Inflammation; Inflammation prophylaxis; Injections, Intraocular; Iodine; Ophthalmic Solutions; Ophthalmology; Patient compliance; Patient safety; Penicillin; Pilot Projects; Postoperative; Postoperative Complications - prevention & control; Prophylaxis; Retrospective Studies; Silicones; Small gauge vitrectomy; Statistical analysis; Steroid hormones; Subconjunctival injections; Surgeons; Surgery; Surgical outcomes; Tamponade; Vancomycin; Vitrectomy - methods; Vitreoretinal surgery; Vitreoretinal surgery; Endophthalmitis; Subconjunctival injections; Inflammation prophylaxis; Dropless MIVS; Small gauge vitrectomy
• ISSN: 1471-2415; 1471-2415
• DOI: 10.1186/s12886-023-02943-z

Perioperative infection and inflammation prophylaxis after ocular surgery has evolved over the years along with improvements in surgical equipment and a growing interest in alternatives to the standard topical eye drops. The purpose of this study is to evaluate the outcomes of a novel, modified-dropless protocol for 23-gauge (23-G), 25-gauge (25-G) and 27-gauge (27-G) micro-incision vitrectomy surgery (MIVS) that omits any intraocular injections of antibiotics or steroids. This Institutional Review Board-approved, single-surgeon retrospective study reviewed MIVS post-surgical outcomes in patients who received a modified-dropless protocol from February 2020 to March 2021. A total of 158 charts were reviewed, of which 150 eyes met the eligibility criteria. After each case, patients were administered a 0.5 cc subconjunctival injection of a 1:1 Cefazolin (50 mg/cc):Dexamethasone (10 mg/cc) in the inferior fornix and 0.5 cc of posterior Sub-Tenon's Kenalog (STK). No intravitreal injections were administered, and no pre- or postoperative antibiotic or steroid eye drops were prescribed. For patients allergic to penicillin, separate subconjunctival injections of 0.25 cc each of Vancomycin (10 mg/cc) and Dexamethasone (10 mg/cc) were administered. The primary safety parameter was postoperative cases of endophthalmitis. Secondary endpoints consisted of Best-Corrected Distance Visual Acuity (BCVA), intraocular pressure (IOP), and postoperative complications (retinal detachments, inflammation, need for additional surgery) within three months of surgery. Statistical analysis was performed using chi-square (χ²) tests for categorical values, and a Student's t-test to compare continuous outcomes. The majority of surgeries (96%) were performed with the 27G MIVS platform. There were no cases of postoperative endophthalmitis. Mean logMAR BCVA improved from 0.71 (± 0.67) to 0.61 (± 0.60) post-operatively (p = 0.02). Excluding patients who had silicone oil tamponade, postoperative BCVA improved from 0.67 (± 0.66) to 0.54 (± 0.55) (p = 0.003). Mean IOP increased from 14.6 (± 3.8) to 15.3 (± 4.1) (p = 0.05). Ten patients required further medication therapy for an increase in IOP, one had inflammatory signs, and 14 required a second surgical intervention mostly due to recurrences of initial surgical indication. A modified-dropless postoperative protocol involving subconjunctival and posterior sub-Tenon's injections only may be a safe and convenient alternative to topical eye drops for patients undergoing MIVS, but additional and larger studies are needed.