McGregor N. Lott

23-gauge vitrectomy in 100 eyes: short-term visual outcomes and complications.

Purpose: To report the short-term outcomes and complications of patients undergoing 23-gauge transconjunctival sutureless pars plana vitrectomy. Methods: Retrospective, consecutive, noncomparative case series in which 100 eyes of 100 patients underwent elective 23-gauge pars plana vitrectomy for a variety of surgical indications. All patients were examined on postoperative day 1 and then approximately 1 and 4 weeks later. Demographic and ophthalmic data were recorded. Results: Fifty-two men and 48 women (mean age = 65 years) were observed for a mean of 26 weeks. Mean preoperative visual acuity was 20/842 and mean final postoperative visual acuity was 20/429. Postoperative visual acuity improved in 68% of patients, worsened in 16%, and remained unchanged in 16%. Mean preoperative intraocular pressure was 15 mmHg and mean postoperative intraocular pressure at final visit was 14 mmHg. No sutures were required to close sclerotomies and no intraoperative complications were observed, though one eye required conversion to 20-gauge pars plana vitrectomy during silicone oil removal. Postoperative complications included retinal detachment, cataract progression, vitreous hemorrhage, persistent macular hole, new macular hole, phthisis, posterior capsular opacification, and severe chemosis. Conclusions: Twenty-three-gauge pars plana vitrectomy demonstrates short-term visual outcomes and complication rates that are comparable to those reported with 20- and 25-gauge systems.

Vitreal penetration of oral moxifloxacin in humans.

Purpose: To investigate the vitreal penetration of moxifloxacin after oral administration. Design: Prospective, nonrandomized clinical series. Methods: Twenty-four patients (mean age = 62.8 years) undergoing elective pars plana vitrectomy were assigned to a dosing group: control (n = 3), which received no medication; single-dose (n = 11), which received one 400 mg oral dose of moxifloxacin 3 hours before surgery; and five-dose (n = 10), which received one 400 mg dose on each of the 4 days preceding surgery and a fifth dose 3 hours before surgery. Vitreous samples were obtained and analyzed. Results: Control, below quantifiable levels; single-dose, 0.572 ± 0.239 μg/mL; and five-dose, 1.200 ± 0.645 μg/mL. Conclusions: Five doses of oral moxifloxacin lead to higher intravitreal drug concentrations than single-dose administration. Both regimens, however, achieve levels that exceed the MIC90 of many bacteria implicated in postoperative endophthalmitis.