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. 2018 Feb 8:10:87-90.
doi: 10.1016/j.ajoc.2018.02.007. eCollection 2018 Jun.

Late-onset bleb-associated endophthalmitis and continuous positive airway pressure

Erich J Berg  1 , John B Davies  2 , Mark R Buboltz  1 , Thomas W Samuelson  1
Affiliations

Late-onset bleb-associated endophthalmitis and continuous positive airway pressure

Erich J Berg et al. Am J Ophthalmol Case Rep. .

Abstract

Purpose: To raise awareness of a possible association between continuous positive airway pressure (CPAP) devices and postoperative bleb-related infection.

Observations: A 57-year old patient on CPAP presented with unilateral bleb-associated endophthalmitis 32 months after routine ExPress Trabeculectomy with mitomycin C. The offending organism, Streptococcus mitis, is a nonmotile and generally non-virulent pathogen which predominates in the normal human respiratory flora.

Conclusions and importance: This conceptual report underscores a potential relationship between CPAP use and bleb-associated endophthalmitis. Streptococcal species are the most commonly reported causative organisms in bleb-associated endophthalmitis, and S. mitis is of particular concern as the most abundant microbe among all human oral flora. A logical risk factor for infection, the CPAP device may inadvertently deliver such organisms to the vulnerable conjunctival filtering bleb.

Keywords: Bleb; Continuous positive airway pressure; Endophthalmitis; Express trabeculectomy; Mitomycin C; Streptococcus mitis.

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