Delayed-onset bleb-associated endophthalmitis: Clinical features and visual acuity outcomes

Alice Song, Ingrid U. Scott, M. P.H.Harry W. Flynn, Donald L. Budenz

Research output: Contribution to journalArticle

134 Citations (Scopus)

Abstract

Objective: To investigate clinical factors, causative organisms, treatments, and visual acuity and intraocular pressure outcomes associated with delayed-onset, bleb-associated endophthalmitis. Design: Retrospective, noncomparative, consecutive case series. Participants: All patients treated for bleb-associated endophthalmitis at Bascom Palmer Eye Institute between January 1, 1996, and July 1, 2001. All patients had prior glaucoma filtering surgery. Patients with inadvertent functioning blebs after cataract extraction were excluded. Main Outcome Measures: Visual acuity outcomes and intraocular pressure control after endophthalmitis. Results: An antifibrotic agent was used in 40 (82%) of the 49 eyes identified, including mitomycin-C in 33 (67%) and 5-fluorouracil (5-FU) in 7 (14%). The mean interval between the initial filtering surgery and endophthalmitis diagnosis was 5.0 years (range, 0.7-12.2 years). The mean follow-up time after treatment for endophthalmitis was 6.9 months (range, 1-60 months). As recorded in the medical record, potential risk factors and clinical features among the study population included history of bleb leak in 13 (27%) eyes, bleb manipulations in 15 (31 %) (needling in 3 [6%], compression sutures in 2 [4%], laser suture lysis in 6 [12%], bleb revision in 5 [10%], and autologous blood injection in 2 [4%]), bleb defects in 6 (12%), inferior bleb location 6 (12%), and nasolacrimal duct obstruction in 1 (2%). The most common causative organisms were Streptococcus species in 15 eyes (31 %) and Staphylococcus species in 11 eyes (22%). Final visual acuities in the vitrectomy group (n = 22) versus the initial tap group (n = 26) were as follows: ≥ 20/40 (5% versus 15%), 20/50 to 20/400 (32% versus 54%), and <5/200 (64% versus 31 %). Eleven (22%) patients eventually underwent enucleation or evisceration secondary to pain and/or poor vision (light perception to no light perception). In 4 (11 %) of the 38 eyes not enucleated, intraocular pressures were poorly controlled at last follow-up (>21 mmHg) after treatment of endophthalmitis. Conclusions: Streptococcus species and Staphylococcus species were the most common causative organisms in the current series of patients with delayed-onset bleb-associated endophthalmitis. Despite successful treatment of the infection, visual outcomes are generally poor.

Original languageEnglish (US)
Pages (from-to)985-991
Number of pages7
JournalOphthalmology
Volume109
Issue number5
DOIs
StatePublished - May 14 2002

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Endophthalmitis
Blister
Visual Acuity
Filtering Surgery
Streptococcus
Intraocular Pressure
Staphylococcus
Sutures
Nasolacrimal Duct
Cataract Extraction
Vitrectomy
Mitomycin
Therapeutics
Fluorouracil
Glaucoma
Medical Records
Lasers
Outcome Assessment (Health Care)
Injections

All Science Journal Classification (ASJC) codes

  • Ophthalmology

Cite this

Song, Alice ; Scott, Ingrid U. ; Flynn, M. P.H.Harry W. ; Budenz, Donald L. / Delayed-onset bleb-associated endophthalmitis : Clinical features and visual acuity outcomes. In: Ophthalmology. 2002 ; Vol. 109, No. 5. pp. 985-991.
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title = "Delayed-onset bleb-associated endophthalmitis: Clinical features and visual acuity outcomes",
abstract = "Objective: To investigate clinical factors, causative organisms, treatments, and visual acuity and intraocular pressure outcomes associated with delayed-onset, bleb-associated endophthalmitis. Design: Retrospective, noncomparative, consecutive case series. Participants: All patients treated for bleb-associated endophthalmitis at Bascom Palmer Eye Institute between January 1, 1996, and July 1, 2001. All patients had prior glaucoma filtering surgery. Patients with inadvertent functioning blebs after cataract extraction were excluded. Main Outcome Measures: Visual acuity outcomes and intraocular pressure control after endophthalmitis. Results: An antifibrotic agent was used in 40 (82{\%}) of the 49 eyes identified, including mitomycin-C in 33 (67{\%}) and 5-fluorouracil (5-FU) in 7 (14{\%}). The mean interval between the initial filtering surgery and endophthalmitis diagnosis was 5.0 years (range, 0.7-12.2 years). The mean follow-up time after treatment for endophthalmitis was 6.9 months (range, 1-60 months). As recorded in the medical record, potential risk factors and clinical features among the study population included history of bleb leak in 13 (27{\%}) eyes, bleb manipulations in 15 (31 {\%}) (needling in 3 [6{\%}], compression sutures in 2 [4{\%}], laser suture lysis in 6 [12{\%}], bleb revision in 5 [10{\%}], and autologous blood injection in 2 [4{\%}]), bleb defects in 6 (12{\%}), inferior bleb location 6 (12{\%}), and nasolacrimal duct obstruction in 1 (2{\%}). The most common causative organisms were Streptococcus species in 15 eyes (31 {\%}) and Staphylococcus species in 11 eyes (22{\%}). Final visual acuities in the vitrectomy group (n = 22) versus the initial tap group (n = 26) were as follows: ≥ 20/40 (5{\%} versus 15{\%}), 20/50 to 20/400 (32{\%} versus 54{\%}), and <5/200 (64{\%} versus 31 {\%}). Eleven (22{\%}) patients eventually underwent enucleation or evisceration secondary to pain and/or poor vision (light perception to no light perception). In 4 (11 {\%}) of the 38 eyes not enucleated, intraocular pressures were poorly controlled at last follow-up (>21 mmHg) after treatment of endophthalmitis. Conclusions: Streptococcus species and Staphylococcus species were the most common causative organisms in the current series of patients with delayed-onset bleb-associated endophthalmitis. Despite successful treatment of the infection, visual outcomes are generally poor.",
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Delayed-onset bleb-associated endophthalmitis : Clinical features and visual acuity outcomes. / Song, Alice; Scott, Ingrid U.; Flynn, M. P.H.Harry W.; Budenz, Donald L.

In: Ophthalmology, Vol. 109, No. 5, 14.05.2002, p. 985-991.

Research output: Contribution to journalArticle

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T1 - Delayed-onset bleb-associated endophthalmitis

T2 - Clinical features and visual acuity outcomes

AU - Song, Alice

AU - Scott, Ingrid U.

AU - Flynn, M. P.H.Harry W.

AU - Budenz, Donald L.

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N2 - Objective: To investigate clinical factors, causative organisms, treatments, and visual acuity and intraocular pressure outcomes associated with delayed-onset, bleb-associated endophthalmitis. Design: Retrospective, noncomparative, consecutive case series. Participants: All patients treated for bleb-associated endophthalmitis at Bascom Palmer Eye Institute between January 1, 1996, and July 1, 2001. All patients had prior glaucoma filtering surgery. Patients with inadvertent functioning blebs after cataract extraction were excluded. Main Outcome Measures: Visual acuity outcomes and intraocular pressure control after endophthalmitis. Results: An antifibrotic agent was used in 40 (82%) of the 49 eyes identified, including mitomycin-C in 33 (67%) and 5-fluorouracil (5-FU) in 7 (14%). The mean interval between the initial filtering surgery and endophthalmitis diagnosis was 5.0 years (range, 0.7-12.2 years). The mean follow-up time after treatment for endophthalmitis was 6.9 months (range, 1-60 months). As recorded in the medical record, potential risk factors and clinical features among the study population included history of bleb leak in 13 (27%) eyes, bleb manipulations in 15 (31 %) (needling in 3 [6%], compression sutures in 2 [4%], laser suture lysis in 6 [12%], bleb revision in 5 [10%], and autologous blood injection in 2 [4%]), bleb defects in 6 (12%), inferior bleb location 6 (12%), and nasolacrimal duct obstruction in 1 (2%). The most common causative organisms were Streptococcus species in 15 eyes (31 %) and Staphylococcus species in 11 eyes (22%). Final visual acuities in the vitrectomy group (n = 22) versus the initial tap group (n = 26) were as follows: ≥ 20/40 (5% versus 15%), 20/50 to 20/400 (32% versus 54%), and <5/200 (64% versus 31 %). Eleven (22%) patients eventually underwent enucleation or evisceration secondary to pain and/or poor vision (light perception to no light perception). In 4 (11 %) of the 38 eyes not enucleated, intraocular pressures were poorly controlled at last follow-up (>21 mmHg) after treatment of endophthalmitis. Conclusions: Streptococcus species and Staphylococcus species were the most common causative organisms in the current series of patients with delayed-onset bleb-associated endophthalmitis. Despite successful treatment of the infection, visual outcomes are generally poor.

AB - Objective: To investigate clinical factors, causative organisms, treatments, and visual acuity and intraocular pressure outcomes associated with delayed-onset, bleb-associated endophthalmitis. Design: Retrospective, noncomparative, consecutive case series. Participants: All patients treated for bleb-associated endophthalmitis at Bascom Palmer Eye Institute between January 1, 1996, and July 1, 2001. All patients had prior glaucoma filtering surgery. Patients with inadvertent functioning blebs after cataract extraction were excluded. Main Outcome Measures: Visual acuity outcomes and intraocular pressure control after endophthalmitis. Results: An antifibrotic agent was used in 40 (82%) of the 49 eyes identified, including mitomycin-C in 33 (67%) and 5-fluorouracil (5-FU) in 7 (14%). The mean interval between the initial filtering surgery and endophthalmitis diagnosis was 5.0 years (range, 0.7-12.2 years). The mean follow-up time after treatment for endophthalmitis was 6.9 months (range, 1-60 months). As recorded in the medical record, potential risk factors and clinical features among the study population included history of bleb leak in 13 (27%) eyes, bleb manipulations in 15 (31 %) (needling in 3 [6%], compression sutures in 2 [4%], laser suture lysis in 6 [12%], bleb revision in 5 [10%], and autologous blood injection in 2 [4%]), bleb defects in 6 (12%), inferior bleb location 6 (12%), and nasolacrimal duct obstruction in 1 (2%). The most common causative organisms were Streptococcus species in 15 eyes (31 %) and Staphylococcus species in 11 eyes (22%). Final visual acuities in the vitrectomy group (n = 22) versus the initial tap group (n = 26) were as follows: ≥ 20/40 (5% versus 15%), 20/50 to 20/400 (32% versus 54%), and <5/200 (64% versus 31 %). Eleven (22%) patients eventually underwent enucleation or evisceration secondary to pain and/or poor vision (light perception to no light perception). In 4 (11 %) of the 38 eyes not enucleated, intraocular pressures were poorly controlled at last follow-up (>21 mmHg) after treatment of endophthalmitis. Conclusions: Streptococcus species and Staphylococcus species were the most common causative organisms in the current series of patients with delayed-onset bleb-associated endophthalmitis. Despite successful treatment of the infection, visual outcomes are generally poor.

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