Abstract
Purpose To report the risk factors, causative organisms and visual outcomes in patients with late-onset bleb-related endophthalmitis.
Methods Medical records of all patients with the clinical diagnosis of late-onset bleb-related endophthalmitis undergoing vitreous aspirates for culture at our institution from January 1987 to July 1996 were reviewed. Late-onset bleb-related endophthalmitis was defined as conjunctival injection, bleb purulence and intraocular inflammation developing at least 1 month following filtering surgery.
Results Forty-nine cases of bleb-related endophthalmitis developed in 42 patients (23 men, 19 women). Mean patient age was 62.1 ± 19.3 years (range 5-94 years). Thirty-nine patients underwent prior filtering surgery (superior trabeculectomy, 24 eyes; inferior trabeculectomy, 10 eyes;combined superior trabeculectomy/cataract extraction, 4 eyes;posterior lip sclerectomy, 1 eye) and 3 had inadvertent blebs following cataract extraction. Endophthalmitis developed an average of 25.4 ± 23.5 months (range 1-96 months) post-operatively. Antifibrosis agents were used in 25 of 39 eyes undergoing filtering surgery (mitomycin C, 13 eyes;5-fluorouracil, 12 eyes). Bleb leaks were documented in a total of 32 of 49 (65%) cases either before or at the time of endophthalmitis diagnosis. Vitreous cultures were positive in 42 of 49 (86%) cases. The most frequently cultured organisms were Staphylococcus aureus (13), Staphylococcus epidermidis (12), Streptococcus species (8) and Haemophilus influenzae (2). A final visual acuity of 20/400 or better was achieved in 32 of 49 (65%) cases.
Conclusions Staphylococcal species were the most frequently cultured organisms in this series and may be associated with better visual outcomes. Although a causal relationship cannot be established, these results suggest a strong association between bleb leaks and endophthalmitis.
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Supported in part by The New York Glaucoma Research Institute, New York, NY
Presented in part at the Annual Meeting of the Association for Research in Vision and Ophthalmology, Fort Lauderdale, Florida, 15 May, 1997
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Waheed, S., Ritterband, D., Greenfield, D. et al. New patterns of infecting organisms in late bleb-related endophthalmitis: A ten year review. Eye 12, 910–915 (1998). https://doi.org/10.1038/eye.1998.237
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DOI: https://doi.org/10.1038/eye.1998.237
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