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• W2890781097 abstract "We read with interest ‘Outcomes of scleral buckling using chandelier endoillumination’ Hu et al. (2017), who have documented outcomes and complications from this emerging trend in vitreoretinal surgery. We wish to supplement their experience by submitting a case of Staphylococcus Epidermidis endophthalmitis due to chandelier endoillumination use during a primary scleral buckle repair for a rhegmatogenous retinal detachment. Described in 2012 (Aras et al. 2012), chandelier-assisted scleral buckle surgery is said to have some advantages over traditional techniques. These include improved magnification, the ability for trainees and theatre staff to see what the principal surgeon is seeing, facilitation of bimanual manipulation of tissue and faster surgical time (Narayanan et al. 2016). If retinal visualization is improved, then it is possible that outcomes would be better than with conventional buckling procedures, although this has not been consistently demonstrated. Lens touch during cryotherapy and ocular manipulation has been reported as a complication, as has vitreous wick and associated retinal tear (Narayanan et al. 2016). While theoretical risk of endophthalmitis has been discussed in the literature, including in Hu et al.'s series, this is, to our knowledge, the first case of endophthalmitis due to chandelier endoillumination in a scleral buckling procedure. An otherwise healthy 23-year-old man presented with an incidentally noted visual field defect in the left eye and was found to have a superotemporal macula-on rhegmatogenous retinal detachment due to four small atrophic round holes. The visual acuity at time of presentation was VAR 6/6 and VAL 6/12. There was no posterior vitreous detachment. He had a past history of right macula-off rhegmatogenous retinal detachment, also due to atrophic round holes, repaired two years earlier with cryotherapy/buckle. There was no significant blepharitis. A left cryo/buckle procedure was performed under general anaesthetic. Povidone iodine 5% was used with sterile draping. Standard peritomy and rectus muscle slinging followed. A 25G endoillumination chandelier light source (Synergetics, O'Fallon, MO, USA) was placed superonasally, 4 mm posterior to the limbus to allow visualization of the retina using a BIOM wide-angle noncontact microscope-mounted viewing system (Oculus Surgical, Port St. Lucie, FL, USA). The retinal holes were identified, cryotherapy applied, and a 180-degree segmental 506 sponge was sutured in place using three 5/0 Mersilene sutures. There was no drainage of subretinal fluid. An anterior chamber paracentesis was performed to facilitate suture tightening and prevent closure of the central retinal artery. As the endoilluminator was removed at the end of the procedure, a small vitreous wick was noted. This was cut flush with the scleral surface, and the port was sutured with 7/0 vicryl. The conjunctiva was closed with 7/0 Vicryl. Subconjunctival cefazolin 50 mg and dexamethasone 2 mg were given. On day 5, the patient represented with hand movement vision and a clinical picture consistent with endophthalmitis. The patient proceeded promptly to a 25G three-port pars plana vitrectomy/ removal of buckle/and intravitreal antibiotic injection (vancomycin 2 mg in 0.2 ml and ceftazidime 2.25 mg in 0.1 ml). The patient recovered to 6/6 vision. The likely cause of endophthalmitis in this case was the 25G chandelier port rather than the anterior chamber paracentesis given the predominantly posterior focus of infection. The authors would suggest surgeons consider whether adding a chandelier to their scleral bucking procedure is likely to improve the outcomes of surgery. If retinal visualization is improved, then it is possible that outcomes will be better, although this has not yet been demonstrated. This case highlights the small but real risk of endophthalmitis and acts as an important counterpoint to the experiences detailed in Hu et al.'s series." @default.
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• W2890781097 date "2018-09-05" @default.
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• W2890781097 title "Postoperative endophthalmitis following chandelier-assisted scleral buckle for primary repair of rhegmatogenous retinal detachment" @default.
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• W2890781097 doi "https://doi.org/10.1111/aos.13764" @default.
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