ABSTRACT
INTRODUCTION: The incidence of post vitrectomy endophthalmitis (PVE) is reported to be between 0.02 and 0.84%. Resterilization of single use instruments is a common practice amidst developing countries to make it more affordable to the patients by reducing the cost of the surgery and also reduce the environmental hazard. The aim of our study is to evaluate the incidence of PVE amidst existing sterilization practices of reused instruments in multiple vitreoretinal centres in India. METHODOLOGY: Centres with an endophthalmitis tracking system were invited to participate in a survey. Twenty-five centres were sent a questionnaire via email. The questionnaire included details about the institution, number of vitrectomies performed in a year, sterilization practices followed pre-operatively, intraoperatively and postoperatively, incidence of endophthalmitis and instrument reuse policies. RESULTS: A total of 29 cases of endophthalmitis were reported out of the 47,612 vitrectomies performed across various centres. The mean incidence of endophthalmitis was 0.06%. There was no difference in the rates of endophthalmitis based on various pre-operative, intraoperative or postoperative prophylactic measures. Nearly 80% of the centres change most of the instruments after every case, while the rest reused. The mean number of times a cutter was being reused until discarded was 4.7. Nearly 76% followed a performance-based protocol, and the remaining 24% had a fixed protocol for the number of times an instrument can be reused before discarding it. CONCLUSION: PVE rates are not significantly different in India despite the multiuse of single use instruments. The purpose of this paper is not to suggest an alternate protocol but to creating one in the future with these results in mind, to rationalise the use of single use instruments, make VR surgery more affordable and also have a positive impact on the carbon footprint of consumables in surgery.
Subject(s)
Endophthalmitis , Eye Infections, Bacterial , Humans , Vitrectomy/adverse effects , Vitrectomy/methods , Postoperative Complications/etiology , Incidence , Eye Infections, Bacterial/etiology , Retrospective Studies , Endophthalmitis/epidemiology , Endophthalmitis/etiology , Endophthalmitis/prevention & control , India/epidemiologyABSTRACT
PURPOSE: To report a unique case of the branch retinal artery occlusion in a 6-year-old child due to hamartoma. METHOD: A 6-year-old male child presented with chief complaints of foreign body sensation in the left eye without any significant antecedent history of local or systemic cause. Best-corrected visual acuity in the left eye was 20/20. Fundus biomicroscopy revealed altered fundal reflex in superotemporal quadrant and gliotic tissue (Hamartoma) at the first bifurcation of the superior branch of retinal artery. Phakomatosis were ruled out with pediatrician consultation. RESULTS: All related blood investigations were normal. Optical coherence tomography showed focal thinning and optical coherence tomography angiography showed capillary nonperfusion in the corresponding quadrant of the retina. Fluoroscopy under general anesthesia confirmed the diagnosis. We came to the diagnosis of branch retinal artery occlusion may be because of local compression by the hamartoma. CONCLUSION: Three factors controls the occurrence of the vascular occlusion according to Virchow that is, hypercoagulability, hemodynamic changes, and endothelial injury/dysfunction. In our patient, external compression causing hemodynamic changes and subsequent endothelial injury/dysfunction, which promotes thrombosis seems to be the cause of the branch retinal artery occlusion. Patient was advised scheduled periodic follow-up.
