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AS Ching, JC Affeldt, G Baerveldt, L Bruce-Lyle; Late-Onset Glaucoma Implant Device Associated Sterile Endophthalmitis . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3429.
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Purpose: To document a previously unreported entity of sterile late-onset glaucoma implant device (GID) associated endophthalmitis, and to contrast it with its recently described culture-positive counterpart in terms of presentation, etiology, treatment, and outcome. Methods: Four eyes of 3 patients implanted an average of 6 months prior (range 3.6-10.1 months) with Ahmed (2) and Baerveldt (2) GIDs, presented with signs and symptoms of hypopyon (4), vision loss (4), and pain (2) clinically suggestive of endophthalmitis. An exposed nylon scleral graft anchoring suture was identified in 2 eyes. Two eyes underwent vitreous tap (with negative culture) and intraocular antibiotic injection, 1 received intensive topical antibiotics and steroids as well as systemic antibiotics, and 1 received oral steroids only. No GIDs were explanted. Results: All eyes responded rapidly to treatment with vision returning to baseline levels in three of four eyes (75%), while pressure remained well controlled in all eyes. Conclusion: In contrast to its culture-positive counterpart, late-onset GID associated sterile endophthalmitis may present without pain, be associated with exposed scleral graft anchoring sutures, not require GID explantation, and carry a reasonably good visual as well as glaucoma control prognosis. Although 2 patients in this series responded well without vitreous tap or intraocular antibiotics, we still recommend these procedures for all cases of GID-associated inflammation suspicious for endophthalmitis.
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