Abstract
Purpose :
Evaluate the characteristics of patients with trabeculectomy-associated edophthalmitis 15 years after trabeculectomy surgery. With the results, compare the similarities between cases, diagnostic approach of the suspicion of endophtalmitis, as well as the management given to each of the cases.
Methods :
Retrospective, longitudinal, observational, descriptive case series including the clinical records of patients with a diagnosis of late endophthalmitis. Characteristics including age, gender, type of glaucoma, baseline visual acuity (VA), previous surgeries, date of trabeculectomy (TBC),ophthalmological characteristics and past medical history were collected. Transurgical data like peritomy site, and Mitomycin C use characteristics were reviewed. Endophthalmitis features: signs, symptoms VA, date, and years after surgery were collected at onset. Delay on treatment, resolution time, and final VA were considered. Information about: microorganism and antibiotic treatment were recorded. The statistical analysis and results will be published as percentages with confidence intervals.
Results :
Three cases of late onset endophthalmitis were indentifed. Most of them were male (n= 2, 66.6%) and had a mean age of 51.3 ± 7.3 years (range 43 -57 years), 66.6% of the patients had childhood glaucoma (ChG) and 33.3% had steroid-induced glaucoma. All of the eyes were left eye, were myopic, phakic and had MMC use, 66.6% had fornix based trabeculectomy. Age at trabeculectomy surgery was 14.6 ± 11.2 years (range 5 - 27 years). Endophthalmitis visual acuity (VA) presentation was worse than hand movement in 66.6% of the patients; mean IOP at onset was 25 ± 7.54 (range 18-33); all of the patients reported pain and low VA. Treatment delay after endophthalmitis onset was 7.3 ± 11.8 (range 0- 21) days. In the endophthlamitis management 66.6% of the cases required surgery, and 33.3% solved with medical treatment. Resolution time was at 18.6 ± 3.51 (range 15-22) days. Final VA was better than 20/60 in 66.6%. The microorganisms reported were uncommon agents and sensitive to conventional antibiotics.
Conclusions :
Clinical evaluation is crucial in the follow-up period of TBC, and it is important to highlight that it should be for the rest of the patient's life; emphasizing in the bleb localization, morphology, trasudation and thickness, and the antimetabolites. The risk factors should be individualized in each patient.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.