Bleb-associated endophthalmitis: Clinical characteristics and visual outcomes

Brandon G. Busbee, Franco M. Recchia, Richard Kaiser, Parveen Nagra, Brett Rosenblatt, Robert B. Pearlman, Richard K Parrish

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Pages (from-to)1495-1503
Number of pages9
JournalOphthalmology
Volume111
Issue number8
DOIs
StatePublished - Aug 1 2004

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Endophthalmitis
Blister
Vitrectomy
Temazepam
Visual Acuity
Intravitreal Injections
Hand
Anti-Bacterial Agents
Serratia
Therapeutics
Staphylococcus epidermidis
Enterococcus
Outcome Assessment (Health Care)
Morbidity
Biopsy
Light
Incidence

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Busbee, B. G., Recchia, F. M., Kaiser, R., Nagra, P., Rosenblatt, B., Pearlman, R. B., & Parrish, R. K. (2004). Bleb-associated endophthalmitis: Clinical characteristics and visual outcomes. Ophthalmology, 111(8), 1495-1503. https://doi.org/10.1016/j.ophtha.2004.01.028

Bleb-associated endophthalmitis : Clinical characteristics and visual outcomes. / Busbee, Brandon G.; Recchia, Franco M.; Kaiser, Richard; Nagra, Parveen; Rosenblatt, Brett; Pearlman, Robert B.; Parrish, Richard K.

In: Ophthalmology, Vol. 111, No. 8, 01.08.2004, p. 1495-1503.

Research output: Contribution to journalArticle

Busbee, BG, Recchia, FM, Kaiser, R, Nagra, P, Rosenblatt, B, Pearlman, RB & Parrish, RK 2004, 'Bleb-associated endophthalmitis: Clinical characteristics and visual outcomes', Ophthalmology, vol. 111, no. 8, pp. 1495-1503. https://doi.org/10.1016/j.ophtha.2004.01.028
Busbee BG, Recchia FM, Kaiser R, Nagra P, Rosenblatt B, Pearlman RB et al. Bleb-associated endophthalmitis: Clinical characteristics and visual outcomes. Ophthalmology. 2004 Aug 1;111(8):1495-1503. https://doi.org/10.1016/j.ophtha.2004.01.028
Busbee, Brandon G. ; Recchia, Franco M. ; Kaiser, Richard ; Nagra, Parveen ; Rosenblatt, Brett ; Pearlman, Robert B. ; Parrish, Richard K. / Bleb-associated endophthalmitis : Clinical characteristics and visual outcomes. In: Ophthalmology. 2004 ; Vol. 111, No. 8. pp. 1495-1503.
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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.",
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AB - 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.

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