Delayed–onset Bleb–Associated Endophthalmitis: Clinical Features and Visual Acuity Outcomes

Abstract

Abstract: : Purpose:To investigate the clinical features, causative organisms, treatment strategies, and visual acuity outcomes of patients who present with delayed–onset, bleb–associated endophthalmitis. Methods: Retrospective, non–comparative case series of patients who were treated at Bascom Palmer Eye Institute for delayed–onset, bleb–associated endophthalmitis between January 1, 1989 and November 1, 2004. Bleb–associated endophthalmitis was diagnosed at 1 month or more following after surgery in all patients. Results:In this 16 year series, 87 patients have been identified with delayed onset bleb–associated endophthalmitis. An anti–fibrotic agent (including 5–fluorouracil or mitomycin–C) used in 74.5% of patients. At initial presentation, 28.7% (25/87) had evidence of bleb leak. In 85% (74/87) patients a positive culture was identified. The most frequent organisms cultured included streptococcus in 36.8% (32/87) and staphylococcal species in 21.8% (19/87) patients. The initial treatment was a pars plana vitrectomy with injection of intravitreal antibiotics 48.3% (42/87) patients, vitreous tap and injection of intravitreal antibiotics in 48.3% (42/87) patients, and evisceration or enucleation in 3.4% of patients (3/87). Visual acuity at time of presentation was <5/200 in 80.5% (70/87) patients. Final visual acuity was <5/200 in 48.3% (42/87) patients, between 20/50–20/400 in 40.2% (35/87) patients, and +/–20/40 in 11.5 % (10/87) patients. Conclusions: At presentation, many patients have a demonstrable leak within the bleb. Streptococcal and Staphylococcus species are the most common causative organisms. Because of the more virulent organisms involved, these cases often presented with severe intraocular inflammation and were treated with pars plana vitrectomy and injection of intravitreal antibiotics. Delayed–onset bleb associated endophthalmitis is generally associated with a poor visual outcome despite successful treatment of the infection.

Keywords: endophthalmitis • outflow: trabecular meshwork • bacterial disease