Clinical analysis of glaucoma bleb-associated endophthalmitis

Abstract

To investigate the clinical characteristics, causative organisms, treatment procedures and prognosis of glaucoma bleb-associated endophthalmitis. It was a retrospective case series study. All cases were patients with glaucoma bleb-associated endophthalmitis treated at Shandong Eye Institute, Qingdao Eye Hospital between January 1, 1997 and December 31, 2009. All patients had prior glaucoma filtering surgery. Nineteen patients (20 eyes) were identified. There were 16 males (17 eyes, 85%) and 3 females (3 eyes, 15%). The mean age at presentation was (46.9 ± 16.1) years (ranged 15 to 71 years). In 14 patients (15 eyes) the glaucoma operation was performed in our hospital, and an antifibrotic agent was used (mitomycin, 0.5 g/L, 2 min), shallow anterior chamber and hypotony occurred in early postoperative period in 8 eyes (53.3%). Glaucoma operation was performed in other hospitals in 5 patients (5 eyes). Eight cases (8 eyes) received glaucoma operation more than two times. The mean interval between the last filtering surgery and the diagnosis of endophthalmitis was 29.5 ± 32.2 months (ranged 15 days to 10 years). Mainly clinical features included bleb infection, anterior chamber inflammatory exudation, hypopyon and vitreous opacities. Bleb leakage occurred in 63.6% eyes and bleb was located inferiorly in 5 eyes (25.0%). The incidence of inferior bleb-related endophthalmitis was higher than that of the superior bleb (19.2% versus 0.6%). The most common causative organisms were staphylococcus species. The initial treatments included intravenous and topical antibiotics, intravitreal injection of antibiotics, pars plana vitrectomy. These treatments could effectively control the endophthalmitis. The visual prognosis was good, 80% patients achieved increase of vision after treatment and 55% patients regained original visual acuity. Eye ball was preserved in 13 (68.4%) of 19 eyes, intraocular pressure (IOP) was controlled at last follow-up after the treatment of endophthalmitis. IOP was controlled by 1 or 2 drugs in 5 eyes (26.3%) and 1 eye (5.3%) received trabeculectomy. Glaucoma bleb-associated endophthalmitis is a serious complication following glaucoma filtering surgery which threats patients visual acuity significantly. It can occur at any time after the operation. Staphylococcus species is the most common causative organisms. Bleb leakage and inferior bleb location are the possible causative factors. Patients should be immediately treated by intra-vitreal injection and/or vitrectomy. If the treatment is timely and effective, the visual prognosis is good.