Delayed-Onset Endophthalmitis Associated With Glaucoma Drainage Implant.

Area of Science:

• Ophthalmology
• Infectious Diseases
• Glaucoma Surgery

Background:

• Glaucoma drainage implants (GDIs) are used to manage refractory glaucoma.
• Endophthalmitis is a serious intraocular infection that can occur after glaucoma surgery.
• Delayed-onset endophthalmitis associated with GDIs presents unique challenges.

Purpose of the Study:

• To characterize the clinical features, microbial causes, and treatment outcomes of endophthalmitis following glaucoma drainage implant surgery.
• To identify risk factors and prognostic indicators for GDI-associated endophthalmitis.

Main Methods:

• A retrospective case series of patients treated for GDI-associated endophthalmitis between 2013 and 2024.
• Inclusion criteria involved documented vitritis, endophthalmitis, or positive vitreous cultures.
• Data collected included clinical presentation, microbiology, management, and visual acuity outcomes.

Main Results:

• Forty-five eyes of 45 patients were analyzed, with endophthalmitis onset ranging from 6 weeks to 11 years post-implantation (median 4 years).
• Tube or plate exposure was noted in 73% of cases; 51% had positive microbial cultures, including Staphylococcus epidermidis, S. aureus, and mycobacteria.
• Despite treatment including intravitreal antibiotics and pars plana vitrectomy, visual acuity outcomes were poor, with only 22% achieving 20/200 or better; one eye required enucleation.

Conclusions:

• Delayed-onset endophthalmitis is a severe complication of GDI surgery, frequently associated with implant exposure.
• Management often requires implant explantation, and visual prognosis remains guarded.
• Further research into preventative strategies and optimized treatment protocols for GDI-associated endophthalmitis is warranted.