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Five‐year outcomes of a personalized pro re nata treatment regimen with anti‐vascular endothelial growth factor for neovascular age‐related macular degeneration

draping. Standard peritomy and rectus muscle slinging followed. A 25G endoilluminationchandelier light source (Synergetics, O’Fallon, MO, USA) was placed superonasally, 4 mm posterior to the limbustoallowvisualizationoftheretinausing 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-portparsplanavitrectomy/ 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 inHu et al.’s series.