Purchase this article with an account.
Cindy Xin Zheng, Marlene Moster, M. Ali Khan, Sunir Garg, Allen Chiang, Michael Waisbourd; Infectious endophthalmitis following glaucoma drainage implant surgery. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6498.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Endophthalmitis is a rare complication after glaucoma drainage implant (GDI) surgery. In this retrospective study, we report the clinical course, management, and treatment outcomes of endophthalmitis following GDI surgery. To the best of our knowledge, this is the largest case series of endophthalmitis associated with GDIs.
Records of all patients diagnosed with endophthalmitis following GDI surgery from 2007 to 2014 were retrospectively reviewed. A diagnosis of endophthalmitis was based on presentation with pain, redness, and decreased vision with significant vitreous inflammation that was treated with intravitreal antibiotics and/or pars plana vitrectomy (PPV). Data, including clinical course, microbiological laboratory results, and management data, were recorded. The primary outcome measure was final best-corrected visual acuity (BCVA).
Of the 1891 eyes that underwent GDI surgery from 2007 to 2014, a total of 14 eyes (0.7%) were diagnosed with endophthalmitis after GDI surgery. There were 8 eyes (57%) with a Baerveldt glaucoma implant and 6 eyes (43%) with an Ahmed glaucoma valve. The mean time interval between GDI surgery and endophthalmitis was 1.9 years (range 0.4-6.3 years). For initial treatment, 13/14 eyes (93%) underwent vitreous tap and injection of intravitreal antibiotics, and 1/14 (7%) underwent primary PPV. There was GDI erosion in 9/14 eyes (64%). All eroded GDIs were surgically removed, which occurred a mean of 9 days (range 2-29 days) after endophthalmitis was diagnosed. A causative organism was identified in 8/14 eyes (57%). The most common pathogens isolated were staphylococcus (n = 3, 21%) and streptococcus (n = 2, 14%). Overall, logMAR BCVA increased from 0.6 ± 0.5 pre-infection to 1.7 ± 1.1 post-infection. Mean IOP remained stable from 13.2 ± 6.6 pre-infection to 13.4 ± 12.1 post-infection. The final BCVA was not correlated to type of GDI (p = 0.58), location of GDI (p = 0.16), number of previous surgeries (p = 0.58), presence or absence of erosion (p = 0.58), type of microorganism cultured (p = 0.45), or initial treatment strategy (vitreous tap versus PPV, p = 1.0).
Endophthalmitis is a rare complication after GDI surgery that is often delayed in onset. Most cases were associated with GDI erosion. Prompt treatment is required, often with removal of the eroded GDI.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
This PDF is available to Subscribers Only