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. 2011:5:739-44.
doi: 10.2147/OPTH.S17975. Epub 2011 Jun 2.

Delayed-onset bleb-associated endophthalmitis: presentation and outcome by culture result

David J Jacobs  1 , Theodore Leng, Harry W Flynn Jr, Wei Shi, Darlene Miller, Steven J Gedde
Affiliations

Delayed-onset bleb-associated endophthalmitis: presentation and outcome by culture result

David J Jacobs et al. Clin Ophthalmol. 2011.

Abstract

Purpose: To determine how culture results are associated with clinical presentations and outcomes in delayed-onset bleb-associated endophthalmitis (BAE).

Methods: Retrospective consecutive case series of BAE at Bascom Palmer Eye Institute between January 1, 1996 and December 31, 2009. All patients had prior glaucoma filtering surgery. BAE was defined as intraocular infection with vitreous involvement receiving treatment with intravitreal antibiotics. Visual acuity (VA) outcomes and other clinical data were grouped by culture result and compared using the 2-sided Student's t-test.

Main outcome measure: Mean logMAR change at 3 months after treatment (3-month logMARΔ).

Results: Eighty-six eyes of 85 patients were identified. Two eyes were primarily eviscerated. Fifty-three (63%) eyes were culture-positive with the following organisms: Streptococcus, 21 (25%); coagulase-negative Staphylococcus, 9 (11%); Enterococcus, 6 (7%); Gram-negative, 15 (18%); Moraxella, 8 (10%); Pseudomonas, 3 (4%); and Serratia, 3 (4%). Presenting logMAR VA: culture-positive worse than culture-negative cases (2.45 vs 2.19, P = 0.05). Presenting intraocular pressure (IOP): culture-positive higher than culture-negative cases (24 mmHg vs 14 mmHg, P = 0.002). Poor presenting view of the fundus: Streptococcus worse than coagulase-negative Staphylococcus cases (90% vs 44%, P = 0.006), Pseudomonas and Serratia worse than Moraxella cases (100% vs 50%, P = 0.04). Three month logMARΔ: culture-positive worse than culture-negative cases (1.03 vs 0.43, P = 0.02), Streptococcus worse than coagulase-negative Staphylococcus cases (1.44 vs 0.31, P = 0.004), Pseudomonas and Serratia worse than coagulase-negative Staphylococcus cases (2.41 vs 0.31, P = 0.001), Pseudomonas and Serratia worse than Moraxella cases (2.41 vs 0.04, P = 0.001). A culture result of Streptococcus or Serratia was present in 6 of 7 eyes that received an additional treatment of enucleation or evisceration (P = 0.01).

Conclusion: Culture-positive cases were associated with worse presenting VA, higher presenting IOP, and worse VA outcomes than culture-negative cases. Streptococcus, Pseudomonas, and Serratia cases were associated with poor presenting view of the fundus and worse VA outcomes than coagulase-negative Staphylococcus and Moraxella cases.

Keywords: bleb-associated endophthalmitis; culture results; endophthalmitis; trabeculectomy.

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Figures

Figure 1
Figure 1
Photograph of right eye of 66-year-old male presenting with BAE from Streptococcus sp. Presenting VA: HM, IOP: 28 mmHg. Treatment: tap and injection. Final VA: HM, IOP: 12 mmHg. Culture-positive cases were associated with worse presenting VA and higher presenting IOP than culture-negative cases. Abbreviations: BAE, bleb-associated endophthalmitis; HM, hand motion; IOP, intraocular pressure; VA, visual acuity.
Figure 2
Figure 2
Photograph of left eye of 67-year-old male presenting with culture-negative BAE. Presenting VA: 20/200, IOP: 10 mmHg. Treatment: tap and injection. Final VA 20/200, IOP 16 mmHg. Culture-negative cases were associated with better VA outcomes than culture-positive cases. Abbreviations: BAE, bleb-associated endophthalmitis; IOP, intraocular pressure; VA, visual acuity.
Figure 3
Figure 3
Photograph of left eye of 79-year-old female presenting with BAE from Streptococcus sp. Presenting VA: LP, IOP: 40 mmHg. Treatment: pars plana vitrectomy. Final VA: LP, IOP: 0 mmHg. Only 45% of Streptococcus cases had VA outcomes ≥ 20/400. Abbreviations: BAE, bleb-associated endophthalmitis; IOP, intraocular pressure; LP, light perception; VA, visual acuity.
Figure 4
Figure 4
Photograph of left eye of 72-year-old female with BAE from Moraxella sp. Presenting VA: 1/200, IOP: 35 mmHg. Treatment: tap and injection. Final VA: 20/25, IOP: 11 mmHg. Moraxella cases were associated with a better presenting view of the fundus and better VA outcomes than Pseudomonas and Serratia cases. Abbreviations: BAE, bleb-associated endophthalmitis; IOP, intraocular pressure; VA, visual acuity.
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