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Lekha Mukkamala, Rana J Mady, Lisa Athwal, Marco A Zarbin, Neelakshi Bhagat; Outcomes of Bleb-Related Endophthalmitis: A 15-Year Review at a Tertiary Care Center. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5501.
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© ARVO (1962-2015); The Authors (2016-present)
Bleb-related endophthalmitis (BRE) is an uncommon but serious and potentially blinding infection that can occur at any time after glaucoma surgery. We describe the functional outcomes of patients who presented with BRE at a tertiary care center over 15 years.
A retrospective chart review of patients that presented to University Hospital, Newark, NJ with BRE from 2001-2016 was conducted. Demographics, past medical and ocular history, presenting features, treatment, microbiology, visual outcomes, and complications were recorded.
36 patients with 36 eyes (21 females) post- glaucoma surgery (30 trabeculectomies, 6 tubes) were identified. Most patients (78%) had primary open angle glaucoma; 21 were pseudophakic. Half of patients were blind in the fellow eye. Average time from procedure to onset of BRE was 4.6 years (maximum 33 years). At least 10 patients presented with blebitis an average of 6 days before developing endophthalmitis.Mean visual acuity (VA) and intraocular pressure (IOP) at presentation were HM and 19mmHg, respectively. The most common presenting complaints were eye redness (100%), pain (97%), and decreased VA (92%). 28 of 34 patients had a hypopyon (mean height 1mm). Purulent blebitis was seen in 87% eyes. Vitritis was documented by exam or B-scan in 89% of patients. Cultures (mostly vitreous) were performed in 35 of 36 cases, 19 of which were obtained before antibiotics were started. Only 57% were positive and of those 75% were of Staph or Strep species.The treatment course and initial and final VA and IOP are shown in Table 1. All patients received intravitreal antibiotic injections (most commonly vancomycin and ceftazidime) along with systemic antibiotics (32 of 36 with IV antibiotics). 72% (n=26) of patients underwent pars plana vitrectomy (PPV) with intravitreal antibiotics.Average time to documented resolution was 15 days (n=29) from onset, with mean VA of HM and IOP of 15.3mmHg. 3 patients were enucleated and 7 were NLP. 83% had final VA worse than 20/200 at resolution. The most common complication was choroidal detachment (n=5).
BRE is a visually devastating infection with very poor visual prognosis. Early diagnosis and aggressive treatment with antibiotics are important to maximize visual potential.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Table 1. Treatment course with VA and IOP (T/I= tap and injection of intravitreal antibiotics, PPV=pars plana vitrectomy with intravitreal antibiotics).
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