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the incidence of endophthalmitis after 20-gauge , 23-gauge , and 25-gauge pars plana vitrectomy ( ppv ) was recently reported to be 1/4,403 ( 0.02% ) , 1/3,362 ( 0.03% ) , and 1/789 ( 0.13% ) , respectively .
although rare , endophthalmitis is a vision - threatening complication following ppv . a multicenter , retrospective , interventional study reported the postoperative complications of 27-gauge ppv , including transient ocular hypertension ( 8.4% ) , transient hypotony ( 5.3% ) , and vitreous hemorrhage ( 5.3% ) .
however , no case of postoperative endophthalmitis was encountered . to the best of our knowledge , the incidence of endophthalmitis after
a case of staphylococcus epidermidis endophthalmitis which subsequently developed following 27-gauge ppv for symptomatic vitreous floaters in a healthy young male is hereby reported .
the case followed the tenets of the declaration of helsinki and was approved by the ethics committee of the eye hospital of wenzhou medical university .
a healthy 24-year - old male complained of a 7-year history of an apparent floater after a basketball bump to the left eye , which interfered with his daily life .
neodymium - doped yttrium aluminum garnet ( nd : yag ) vitreolysis was performed a year before the admission ; however , the procedure did not result in his satisfaction .
the admission uncorrected visual acuity ( ucva ) and best - corrected visual acuity ( bcva ) were 0.3 and 1.0 in both eyes , respectively .
spherical equivalent and axial length were around 5 dpt and 26 mm , respectively , in both eyes .
examination was normal except for a prominent posterior vitreous detachment and vitreous opacity in the left eye ( os ) .
observation was advised , but the patient strongly requested treatment . after obtaining informed consent , a 27-gauge sutureless 3-port ppv was performed without intraoperative complications .
tobradex os q2h and tropicamide os qn were administered postoperatively . on the morning of postoperative day 1 ,
anterior segment examination revealed no eyelid edema , mild conjunctival injection , and 1 + aqueous cell with no posterior synechiae , hypopyon , or fibrin .
however , the slit lamp and indirect 90d ophthalmoscope examination was similar as that in the morning .
on the morning of postoperative day 2 , the patient complained of severe pain and blurred vision in the left eye .
the ucva sharply decreased to counting fingers , while the iop was still normal ( 10 mm hg ) .
the slit lamp examination showed mixed conjunctival injection , massive fibrin in the anterior chamber and vitreous chamber , and a blurred fundus ( fig 1a , b ) .
the patient was diagnosed with endophthalmitis and underwent emergent vitreous tap , injection with intravitreal vancomycin ( 1 mg/0.1 ml ) , ceftazidime ( 2.25 mg/0.1 ml ) , triamcinolone ( 0.2 mg ) , and silicone oil injection . during the operation , we observed optic disc congestion and swelling , retinal exudation and hemorrhage , peripheral retinal necrosis , vessel occlusion , and macular edema ( fig 1c ) .
hence , intravenous meropenem 500 mg q8h , dexamethasone 5 mg bid , and topical levofloxacin os q2h , prednisolone os q2h and tropicamide os qid were administered postoperatively .
the eye responded well to the treatment . at day 9 after operation , the ucva and bcva improved to 0.12 and 0.2 , respectively .
the fibrin of the anterior chamber was greatly reduced , and the panoramic ophthalmoscope ( daytona , p200 t ) revealed a visible retina ( fig 2a ) .
spectral domain optical coherence tomography ( heidelberg , tr - kt-2841 , germany ) revealed an irregular retinal surface with a silicone oil interface ( fig 2b ) .
vitreous cultures isolated s. epidermidis , which was susceptible to levofloxacin , vancomycin , gentamicin , and ceftazidime .
intravenous medicine was subsequently stopped , and oral prednisone 30 mg qd ( with a weekly tapered dose ) , was administered . by postoperative month 2 ,
spectral domain optical coherence tomography revealed an irregular retinal surface but an intact ellipsoid layer ( fig 3b ) . at month 5 after operation , the bcva improved to 0.6 .
recent studies found that floaters are perceived by patients as a serious medical condition that has a significant negative impact on their vision and quality of life [ 3 , 4 ] . in a study by webb et al .   with participants aged
30 years on average , 76% reported symptomatic floaters and 33% reported noticeable impairment in vision from floaters .
a utility analysis reported that patients with symptomatic floaters were willing to risk a 7% chance of blindness and 11% risk of death to rid themselves off the symptoms .
clearly , a large proportion of patients are motivated to remove their floaters . at present
, small - gauge vitrectomy seems to be the only effective therapy for symptomatic floaters .
however , though rare , this invasive treatment does have some complications , e.g. , the postoperative cataracts ( frequency ranging from 22.5 to 60% ) [ 6 , 7 , 8 ] , iatrogenic retinal break ( frequency ranging from 0 to 16.4% ) [ 8 , 9 ] , and even endophthalmitis ( 3 cases reported ) [ 10 , 11 ] . in 2 prospective , nationwide studies investigating the endophthalmitis developed after ppv in the uk , park et al . , reported 2 cases of endophthalmitis following 23-gauge ppv for vitreous opacities , both of which were caused by gram - positive cocci ( one was s. epidermidis ) .
one patient regained a visual acuity of 6/9 at 6 months ; however , the other patient developed persistent cystoid macular edema and only recovered 6/96 vision .
recently , henry et al .   reported a case of staphylococcus caprae endophthalmitis in a young healthy female after 20-gauge 3-port vitrectomy for floaters .
the female underwent an emergent vitreous tap and injection with intravitreal vancomycin , ceftazidime , and dexamethasone . at month 9 postoperatively , the female regained a bcva of 20/80 .
to the best of our knowledge , this is the first reported case of endophthalmitis which followed a 27-gauge vitrectomy for floaters .
this case of endophthalmitis was also caused by gram - positive cocci ( s. epidermidis ) , and the patient regained a bcva of 0.6 ( or 30/50 ) at the last follow - up .
more healthy young people with excellent vision are eager to resolve their floaters . although rare , endophthalmitis is a potentially devastating complication for patients undergoing a seemingly straightforward ppv for vitreous floaters .
this severe risk as well as other risks , such as transient hypotony , retinal tear , and long - term complicated cataract , should be explicitly addressed , and consent should be obtained from patients who are considering this treatment modality .
purposeto report a case of staphylococcus epidermidis endophthalmitis following 27-gauge pars plana vitrectomy for symptomatic vitreous floaters.methodsthe clinical course and imaging findings , including fundus optomap , and spectral domain optical coherence tomography of a 24-year - old male patient were documented.resultsthe patient , with a preoperative best - corrected visual acuity ( bcva ) of 1.0 , developed endophthalmitis following 27-gauge pars plana vitrectomy for symptomatic vitreous floaters . after a series of treatments , including emergent vitreous 
 tap and silicone oil injection , antibiotic treatment , and silicone oil removal , the patient regained a bcva of 0.6.conclusionalthough rare , the potential risk of endophthalmitis should be explicitly discussed with patients considering surgical intervention for vitreous floaters .