Bleb-associated endophthalmitis: Clinical characteristics and visual outcomes☆
Presented in part at: American Academy of Ophthalmology 106th Annual Meeting, October, 2002; Orlando, Florida.
Received 21 October 2002; accepted 9 January 2004.
Abstract
Purpose
To analyze the clinical characteristics and treatment outcomes of patients with bleb-associated endophthalmitis (BAE).
Design
Retrospective, noncomparative, interventional case series.
Participants
Consecutive patients treated at one institution for BAE.
Interventions
Prompt pars plana vitrectomy (PPV) with intravitreal injection of antibiotics, or prompt vitreous biopsy and intravitreal injection of antibiotics (tap and inject).
Methods
Retrospective analysis of 68 consecutive cases of BAE between July 1, 1989 and June 30, 2001. Clinical presentation, treatment modality, microbiologic data, and clinical course were analyzed. Visual outcomes were compared between vitrectomy and tap-and-inject groups, culture-positive and culture-negative groups, and early and late times.
Main outcome measures
Snellen visual acuities (VAs) at 3 months and 12 months after treatment and at most recent follow-up.
Results
The incidence of no light perception (NLP) at 12 months after treatment for BAE was 35%. Vitreous isolates included streptococcal species (32% of positive cultures), Staphylococcus epidermidis (26%), Enterococcus, and Serratia (12% each). Patients with a positive vitreous culture had significantly worse VA (median, hand movements [HM] at 3 and 12 months after treatment) and a higher rate of NLP vision. Patients treated with tap-and-inject had a significantly worse final VA (medians, HM at 3 months and LP at 12 months) and a significantly higher rate of NLP vision than patients treated with PPV. One third of patients who underwent PPV achieved a final VA of 20/100 or better 12 months after treatment (P = 0.09).
Conclusions
Bleb-associated endophthalmitis causes significant visual morbidity. Patients with culture-negative BAE and patients treated with prompt PPV may achieve better visual outcome.
1Retina Service, New England Eye Center, Boston, Massachusetts, USA
2Ophthalmic Consultants of Boston, Boston, Massachusetts, USA
3Retina Vitreous Associates, P.C., Nashville, Tennessee, USA
4Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
5Wills Eye Hospital, Philadelphia, Pennsylvania, USA
6Barnes Retina Institute, Washington University School of Medicine, St. Louis, Missouri, USA
7Department of Ophthalmology, Northwestern University School of Medicine, Chicago, Illinois, USA
Correspondence to Brandon G. Busbee, MD, 14 Farwell Place, Cambridge, MA 02138, USA
ABSTRACT