Endophthalmitis after filtering surgery with mitomycin

David Greenfield, Ivan J. Suñer, Michael P. Miller, Tracy A. Kangas, Paul Palmberg, Harry W Flynn

Research output: Contribution to journalArticle

304 Citations (Scopus)

Abstract

Objective: To identify the incidence, causative organisms, and clinical outcomes of eyes with bleb-associated endophthalmitis after glaucoma filtering procedures with adjunctive mitomycin. Methods: Retrospective analysis of 773 consecutive eyes that underwent glaucoma filtering surgery at the Bascom Palmer Eye Institute, Miami, Fla. The course of 609 eyes from 485 patients with a minimum of 3 months of follow-up were reviewed. Results: Mean follow-up was 16.0±11.5 months (range, 3-48 months). Of the 609 eyes, 13 (2.1%) developed bleb-associated endophthalmitis an average of 18.5±13.2 months after surgery (range, 1-45 months). The incidence of bleb-associated endophthalmitis was significantly greater after inferior trabeculectomy (7.8% per patient-year) than after superior trabeculectomy (1.3% per patient-year) by Kaplan-Meier estimates (P=.02, log rank test). The cumulative incidence was 13% for inferior limbal blebs and 1.6% for superior limbal blebs. Nine (69.2%) of the 13 eyes were culture positive. Streptococcus sanguis and Haemophilus influenzae (6/13 [46.2%]) were the most frequent causative organisms. The mean increase in intraocular pressure after endophthalmitis treatment was 1.2 mm Hg, with a mean decrease in visual acuity of 1.42 logMAR units. Eight (61.5%) of the 13 eyes had a final acuity of 20/400 or better. Conclusions: The incidence of bleb-associated endophthalmitis after guarded filtering surgery performed with adjunctive mitomycin is higher than the reported rate in eyes undergoing filtering surgery without the use of antifibrotic agents (0.2%-1.5%). Inferior limbal trabeculectomy carries the highest risk of infection. Eyes with mitomycin blebs maintained excellent filtration capacity. However, after treatment of the infection, the visual outcomes were generally poor.

Original languageEnglish
Pages (from-to)943-949
Number of pages7
JournalArchives of Ophthalmology
Volume114
Issue number8
StatePublished - Aug 1 1996

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Filtering Surgery
Endophthalmitis
Mitomycin
Blister
Trabeculectomy
Incidence
Glaucoma
Streptococcus sanguis
Haemophilus influenzae
Kaplan-Meier Estimate
Infection
Intraocular Pressure
Visual Acuity

ASJC Scopus subject areas

  • Ophthalmology

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Endophthalmitis after filtering surgery with mitomycin. / Greenfield, David; Suñer, Ivan J.; Miller, Michael P.; Kangas, Tracy A.; Palmberg, Paul; Flynn, Harry W.

In: Archives of Ophthalmology, Vol. 114, No. 8, 01.08.1996, p. 943-949.

Research output: Contribution to journalArticle

Greenfield, D, Suñer, IJ, Miller, MP, Kangas, TA, Palmberg, P & Flynn, HW 1996, 'Endophthalmitis after filtering surgery with mitomycin', Archives of Ophthalmology, vol. 114, no. 8, pp. 943-949.
Greenfield, David ; Suñer, Ivan J. ; Miller, Michael P. ; Kangas, Tracy A. ; Palmberg, Paul ; Flynn, Harry W. / Endophthalmitis after filtering surgery with mitomycin. In: Archives of Ophthalmology. 1996 ; Vol. 114, No. 8. pp. 943-949.
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abstract = "Objective: To identify the incidence, causative organisms, and clinical outcomes of eyes with bleb-associated endophthalmitis after glaucoma filtering procedures with adjunctive mitomycin. Methods: Retrospective analysis of 773 consecutive eyes that underwent glaucoma filtering surgery at the Bascom Palmer Eye Institute, Miami, Fla. The course of 609 eyes from 485 patients with a minimum of 3 months of follow-up were reviewed. Results: Mean follow-up was 16.0±11.5 months (range, 3-48 months). Of the 609 eyes, 13 (2.1{\%}) developed bleb-associated endophthalmitis an average of 18.5±13.2 months after surgery (range, 1-45 months). The incidence of bleb-associated endophthalmitis was significantly greater after inferior trabeculectomy (7.8{\%} per patient-year) than after superior trabeculectomy (1.3{\%} per patient-year) by Kaplan-Meier estimates (P=.02, log rank test). The cumulative incidence was 13{\%} for inferior limbal blebs and 1.6{\%} for superior limbal blebs. Nine (69.2{\%}) of the 13 eyes were culture positive. Streptococcus sanguis and Haemophilus influenzae (6/13 [46.2{\%}]) were the most frequent causative organisms. The mean increase in intraocular pressure after endophthalmitis treatment was 1.2 mm Hg, with a mean decrease in visual acuity of 1.42 logMAR units. Eight (61.5{\%}) of the 13 eyes had a final acuity of 20/400 or better. Conclusions: The incidence of bleb-associated endophthalmitis after guarded filtering surgery performed with adjunctive mitomycin is higher than the reported rate in eyes undergoing filtering surgery without the use of antifibrotic agents (0.2{\%}-1.5{\%}). Inferior limbal trabeculectomy carries the highest risk of infection. Eyes with mitomycin blebs maintained excellent filtration capacity. However, after treatment of the infection, the visual outcomes were generally poor.",
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