Document Detail


Delayed-onset bleb-associated endophthalmitis: clinical features and visual acuity outcomes.
MedLine Citation:
PMID:  11986108     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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: > or = 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.
Authors:
Alice Song; Ingrid U Scott; Harry W Flynn; Donald L Budenz
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Ophthalmology     Volume:  109     ISSN:  0161-6420     ISO Abbreviation:  Ophthalmology     Publication Date:  2002 May 
Date Detail:
Created Date:  2002-05-02     Completed Date:  2002-05-16     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7802443     Medline TA:  Ophthalmology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  985-91     Citation Subset:  IM    
Affiliation:
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida 33101, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Anterior Chamber / microbiology
Bacteria / isolation & purification
Endophthalmitis / diagnosis,  etiology*,  therapy
Eye Infections, Bacterial / diagnosis,  drug therapy,  etiology*
Female
Filtering Surgery / adverse effects*
Fluorouracil / therapeutic use
Glaucoma / drug therapy,  surgery
Humans
Intraocular Pressure
Male
Middle Aged
Mitomycin / therapeutic use
Retrospective Studies
Risk Factors
Surgical Wound Infection / diagnosis,  etiology*,  therapy
Visual Acuity*
Vitreous Body / microbiology
Chemical
Reg. No./Substance:
50-07-7/Mitomycin; 51-21-8/Fluorouracil

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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