Visual and Anatomic Outcomes in Delayed-Onset Endophthalmitis After Glaucoma Surgery: A 10-Year Case Series

To evaluate the clinical characteristics, microbiological profiles, and visual and anatomical outcomes of delayed-onset endophthalmitis following trabeculectomy or glaucoma drainage device (GDD) implantation managed with early pars plana vitrectomy (PPV).

This retrospective case series included patients diagnosed with delayed-onset endophthalmitis (≥6 weeks after glaucoma surgery) at a tertiary referral center between 2013 and 2023. Demographics, clinical presentation, microbiological findings, surgical management, and outcomes were reviewed. All eyes underwent PPV within 24 hours of diagnosis, with adjunctive procedures such as bleb excision or GDD explantation performed when indicated. Primary outcomes were best-corrected visual acuity (BCVA) and anatomical success (defined as maintenance of globe integrity without phthisis bulbi or enucleation) at 6 months.

Fifteen eyes of fifteen patients were included (mean age, 50.6 ± 24.0 years). The median interval from glaucoma surgery to infection was 5.2 years (range, 3 months-15 years). Mean presenting BCVA was 3.01 ± 0.34 logMAR, and 93.3% of eyes presented with hand-motion vision. Cultures were positive in 8 cases (53.3%). At 6 months, median BCVA improved to 1.70 logMAR (p < 0.01), and 66.7% of eyes achieved ≥ 1.0 logMAR improvement. No eye progressed to no-light-perception vision or required enucleation. Postoperative complications included transient hypotony (13.3%), elevated intraocular pressure (13.3%), and retinal detachment (6.7%) treated with repeat PPV. Silicone oil tamponade was used in all eyes and was retained long-term in one case (6.7%).

Early PPV combined with appropriate source-control procedures was associated with visual improvement and anatomical success in delayed-onset endophthalmitis after glaucoma surgery.