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L. M. Athwal, R. Fechtner, P. Lama, M. A. Zarbin, N. Bhagat; Infectious Endophthalmitis Related to Glaucoma Procedures; A Retrospective Review. Invest. Ophthalmol. Vis. Sci. 2010;51(13):6037.
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To report the demographics, presenting signs and symptoms, pathogens, treatment, management and visual outcomes of all patients who presented with endophthalmitis after glaucoma surgery to University Hospital (UH), NJMS, Newark, NJ, between 1997 and 2008.
Retrospective case series.
Of 171 patients that presented to UH with infectious exogenous endophthalmitis, 24 (and 24 eyes) were identified to have undergone a glaucoma procedure in the past. These were 14 male and 10 female patients; the mean age was 65.8 years, (range 22 - 94 years). Racial distribution was black 10 patients, white 6, Hispanic 6, and Asian 2. Past glaucoma surgery consisted of trabeculectomy in 21 patients, Baerveldt shunt in 2, and stent removal in 1. The mean duration between glaucoma procedure and endophthalmitis presentation was 5.2 years, (range 2 days - 33 years). Mean duration of follow-up was 32 days (range 9 - 86 days). Cultures were obtained in all 24 eyes (20 vitreous, 3 aqueous, 1 unknown). Cultures were negative in 50% of eyes. Positive cultures included viridans Streptococcus (33%) and Streptococcus pneumoniae (25%).First line of treatment was vitreous or aqueous biopsy with intravitreal antibiotic injection (IAI) in 42% (10 eyes) and pars plana vitrectomy (PPV) with IAI in 58% (14 eyes). Of the 10 patients who underwent IAI as the first line of treatment, 40% (4 eyes) subsequently underwent PPV with IAI, and one subsequently underwent 2 PPVs with IAIs. Of the 14 patients who underwent PPV with IAI as the first line of treatment, 1 patient underwent a second PPV with IAI, 2 patients underwent 2 additional PPVs with IAIs, and 1 patient underwent 3 additional PPVs with IAIs. All but one patient was admitted for intravenous antibiotics. The average length of inpatient stay was 6.5 days (range of 4 - 16 days). The intravitreal injection antibiotics used were vancomycin and ceftazidime in all but two patients, who received vancomycin and amikacin.The mean presenting visual acuity (VA) was a logMAR value of 2.12 and the mean best post-treatment VA was a logMAR value of 1.84. 2 eyes were NLP at presentation and they remained NLP at the end of treatment. 3 patients underwent enucleation for painful blind eye at a mean duration of 4 days after presentation (range of 2 - 8 days); one of them had a concurrent case of orbital cellulitis.
Visual prognosis is poor for patients with post-glaucoma surgery endophthalmitis. A visual acuity of 20/40 or better was only achieved in 4 of 24 (17%) patients, and 7 (29%) patients were left with no light perception in the affected eye.
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