Series examines characteristics of bleb-associated endophthalmitis after glaucoma surgery

Issue: November 10, 2012

A review of bleb-associated endophthalmitis cases found that primary open-angle glaucoma was the most common type of glaucoma and Staphylococcus was the most common causative organism.

Perspective from Douglas J. Rhee, MD

The retrospective study included 31 eyes of 31 patients treated for bleb-associated endophthalmitis between 2003 and 2010. Mean patient age at presentation was 53.7 years.

At time of diagnosis, visual acuity was no light perception in four eyes (12.9%), light perception in 10 eyes (32.3%), hand movement in eight eyes (25.8%), counting fingers in six eyes (19.4%) eyes, and 20/400 or better in three eyes (9.7%).

Cultures were collected from the anterior chamber and vitreous cavity and underwent Gram staining and Giemsa staining.

The mean interval between glaucoma filtering surgery and diagnosis of endophthalmitis was 6.95 years.

Study results showed that primary open-angle glaucoma was diagnosed in 18 eyes (58.1%), primary angle-closure glaucoma in 10 eyes (32.3%), primary congenital glaucoma in two eyes (6.5%) and traumatic glaucoma in one eye (3.2%).

Cultures were positive in nine eyes (32.1%); Staphylococcus was the most common species of micro-organism, appearing in six of the nine positive cultures (66.7%).

At 12 months after treatment, data showed that best corrected visual acuity ranged from 20/30 to no light perception; 12 eyes (38.7%) had visual acuity of 20/400 or better and seven eyes (22.6%) had no light perception, the study authors said.

Perspective

Douglas J. Rhee, MD

The authors of this series of 31 cases of bleb-associated endophthalmitis report that eyes that presented with count fingers or better vision and underwent an initial tap-and-inject treatment had a higher success rate. However, a conclusion of tap-and-inject being superior to pars plana vitrectomy (PPV) is not supported by this study. In this series, only six cases underwent pars plana vitrectomy, and there is no clear description given towards the rationale as to why these six had a PPV. The data do support a better prognosis of eyes that presented with count fingers vision.

Douglas J. Rhee, MD

OSN Glaucoma Board Member

Disclosures: Rhee has no relevant financial disclosures.

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Source:

Eur J Ophthalmol. 2012;22(5):719-725.