Acute-onset endophthalmitis following pars plana vitrectomy for symptomatic vitreous opacities: a case series.

backgroundPars plana vitrectomy (PPV) for symptomatic vitreous opacities, commonly referred to as floaterectomy, is an increasingly performed elective procedure that can meaningfully improve quality of life. However, like all intraocular surgery, it carries the risk of endophthalmitis. To our knowledge, only 2 cases of this complication following floaterectomy have previously been reported. The purpose of this study is to report the largest series of acute-onset bacterial endophthalmitis following floaterectomy, characterizing clinical presentation, causative organisms, antibiotic susceptibilities, histopathology, and visual outcomes.

methodsThis was a retrospective, interventional case series conducted at a tertiary referral center. A query of all patients who underwent PPV for vitreous opacities from January 2010 through December 2025 was performed. Patients were included if they developed acute-onset endophthalmitis (within one month of PPV).

resultsFive eyes of 5 patients were included. Two of 394 patients (0.5%) who underwent floaterectomy at our institution developed acute-onset endophthalmitis; 3 additional cases were referred from outside retina specialists. Mean presenting BCVA was 2.1 logMAR (~ 20/2500). Four of 5 vitreous cultures (80%) were positive: 2 gram-positive (Staphylococcus caprae, Staphylococcus lugdunensis) and 2 gram-negative (Pseudomonas aeruginosa, Serratia marcescens). The institutional endophthalmitis rate of 0.5% was not statistically different from published post-PPV rates of 0.16-0.28% (P = 0.13). Visual outcomes were polarized: 3 of 5 eyes (60%) achieved BCVA ≥ 20/80, while 2 of 5 (40%) progressed to no light perception and underwent enucleation, both involving gram-negative organisms. Histopathology in one enucleated eye demonstrated extensive intraocular necrosis and suppurative inflammation.

conclusionsAcute-onset endophthalmitis following floaterectomy is rare, occurring at a rate statistically similar to PPV for other indications. However, given that floaterectomy is elective surgery for a largely benign, non-vision-threatening condition, the harm-to-benefit ratio is inherently less favorable than PPV performed for sight-threatening pathology. Gram-negative infections were associated with catastrophic and irreversible vision loss, including enucleation. These findings underscore the importance of thorough, candid preoperative counseling regarding the risk of severe infectious complications before proceeding with floaterectomy.