Delayed-onset endophthalmitis associated with conjunctival filtering blebs

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Abstract

Objective: The purpose of the study is to evaluate the causative organisms, treatment methods, and visual acuity outcomes of patients treated for delayed-onset endophthalmitis associated with conjunctival filtering blebs. Methods: The medical records of 32 patients with conjunctival filtering bleb-associated endophthalmitis treated at the Bascom Palmer Eye Institute between 1989 and 1995 were reviewed retrospectively. Bleb- associated endophthalmitis was diagnosed at 1 month or more after surgery in all patients. Patients with bleb infections only but without signs of intraocular infection were excluded from this series. Results: Previous antimetabolite therapy was used in 20 patients, including mitomycin C in 14 and 5-fluorouracil in 6. Streptococcal species were the most frequently cultured organisms occurring in 15 (47%) of 32 eyes. Of the 32 patients, 30 received intraocular antibiotics. The initial treatment included a pars plana vitrectomy in 18 patients and a vitreous tap without vitrectomy in 12 patients. Two of three patients who presented with no light perception vision were treated by evisceration. Overall, 15 (47%) of 32 patients achieved a final visual acuity of 20/400 or better. Of those patients with Streptococcal species cultured from the eye, 6 (40%) of 15 had a visual acuity of 20/400 or better compared to 9 (52%) of 17 in patients with non-Streptococcal species. Conclusions: Delayed-onset endophthalmitis associated with conjunctival filtering blebs is a current and future concern, especially with increasing use of mitomycin C. The Streptococcal species are a common causative organism. Despite current treatment of these patients, the visual acuity outcomes generally are worse than in patients with acute-onset endophthalmitis after cataract surgery.

Original languageEnglish
Pages (from-to)746-752
Number of pages7
JournalOphthalmology
Volume104
Issue number5
StatePublished - May 22 1997

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Endophthalmitis
Blister
Visual Acuity
Vitrectomy
Mitomycin
Patient Acuity
Antimetabolites
Temazepam
Therapeutics
Infection
Fluorouracil
Cataract
Medical Records

ASJC Scopus subject areas

  • Ophthalmology

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Delayed-onset endophthalmitis associated with conjunctival filtering blebs. / Kangas, T. A.; Greenfield, David; Flynn, Harry W; Parrish, Richard K; Palmberg, Paul.

In: Ophthalmology, Vol. 104, No. 5, 22.05.1997, p. 746-752.

Research output: Contribution to journalArticle

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abstract = "Objective: The purpose of the study is to evaluate the causative organisms, treatment methods, and visual acuity outcomes of patients treated for delayed-onset endophthalmitis associated with conjunctival filtering blebs. Methods: The medical records of 32 patients with conjunctival filtering bleb-associated endophthalmitis treated at the Bascom Palmer Eye Institute between 1989 and 1995 were reviewed retrospectively. Bleb- associated endophthalmitis was diagnosed at 1 month or more after surgery in all patients. Patients with bleb infections only but without signs of intraocular infection were excluded from this series. Results: Previous antimetabolite therapy was used in 20 patients, including mitomycin C in 14 and 5-fluorouracil in 6. Streptococcal species were the most frequently cultured organisms occurring in 15 (47{\%}) of 32 eyes. Of the 32 patients, 30 received intraocular antibiotics. The initial treatment included a pars plana vitrectomy in 18 patients and a vitreous tap without vitrectomy in 12 patients. Two of three patients who presented with no light perception vision were treated by evisceration. Overall, 15 (47{\%}) of 32 patients achieved a final visual acuity of 20/400 or better. Of those patients with Streptococcal species cultured from the eye, 6 (40{\%}) of 15 had a visual acuity of 20/400 or better compared to 9 (52{\%}) of 17 in patients with non-Streptococcal species. Conclusions: Delayed-onset endophthalmitis associated with conjunctival filtering blebs is a current and future concern, especially with increasing use of mitomycin C. The Streptococcal species are a common causative organism. Despite current treatment of these patients, the visual acuity outcomes generally are worse than in patients with acute-onset endophthalmitis after cataract surgery.",
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