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Treatment Patterns and Outcomes in Bleb-Related Endophthalmitis: A 9-Year Analysis at a Tertiary Eye Center
Cason B Robbins1, Henry L Feng1, Divakar Gupta1
1Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA.
Insights
Bleb-related endophthalmitis (BRE) often leads to poor visual outcomes despite intensive treatment. Pars plana vitrectomy (PPV) may be necessary, but outcomes can be worse if performed after initial treatment.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Retinal Surgery
Background:
- Bleb-related endophthalmitis (BRE) is a serious complication following glaucoma filtration surgery.
- Early diagnosis and prompt treatment are crucial for visual preservation.
Purpose of the Study:
- To describe the clinical presentation, treatment strategies, and outcomes of BRE.
- To identify factors associated with treatment decisions and visual acuity (VA) outcomes.
Main Methods:
- Retrospective review of 20 patients diagnosed with BRE over a 9-year period.
- Assessment of demographic data, initial management, and VA.
- Analysis of pars plana vitrectomy (PPV) use and its impact on visual outcomes.
Main Results:
- Median time from surgery to presentation was 6.53 years.
- Presenting VA of light perception was significantly associated with initial PPV.
- Twelve eyes (60%) had culture-proven infections; 11 eyes (55%) underwent PPV during treatment.
- Eyes undergoing PPV after initial treatment showed greater VA loss at 6 months.
Conclusions:
- BRE often results in poor visual outcomes despite intensive management.
- While initial PPV may be indicated for light-perception VA, delayed PPV correlated with worse outcomes.
- Further prospective studies are needed to determine the optimal role of PPV in BRE management.
Purpose:
Clinical presentation, treatment choices, and outcomes in cases of bleb-related endophthalmitis (BRE) at a tertiary care center over a 9-year period are described.
Methods:
A retrospective review was conducted of patients diagnosed with BRE at Duke Eye Center (Durham, North Carolina) from January 1, 2009 to January 1, 2018, with at least 6 months of follow-up, assessing demographic data, initial management, and visual acuity (VA).
Results:
Twenty eyes of 20 patients with BRE were identified. Median time from surgery to presentation was 6.53 years. Presenting VA of light perception only was significantly associated with the decision to pursue pars plana vitrectomy (PPV) as initial treatment (odds ratio 59.4, 95% CI, 2.1-1670.8, P = .016). Twelve eyes (60%) had culture-proven infectious endophthalmitis. Eleven eyes (55%) underwent PPV during treatment; 5 eyes underwent PPV on presentation, and 6 eyes underwent PPV after initial presentation. Compared with pre-endophthalmitis VA, 6 eyes that underwent subsequent PPV had greater VA loss at 6 months than cases not undergoing subsequent PPV (Early Treatment Diabetic Retinopathy Study line loss of 14 vs 4 lines, respectively; P = .044).
Conclusions:
BRE eyes presenting with light-perception VA were more likely to undergo initial PPV; yet many eyes in this study required PPV during treatment. Visual outcomes are often poor in BRE despite intensive management. There was greater VA loss from pre-endophthalmitis VA levels at 6 months in eyes undergoing PPV after initial treatment. Prospective studies are needed to assess the optimal role of PPV in patients with BRE.
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