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Late onset endophthalmitis associated with filtering blebs

W B Phillips1, T P Wong, R L Bergren

  • 1Retina Service, Wills Eye Hospital, Philadelphia, Pa. 19107.

Ophthalmic Surgery
|February 1, 1994
PubMed
Summary

Late onset endophthalmitis, often occurring years after surgery, is frequently associated with glaucoma surgery filtering blebs. Predisposing factors include bleb leaks, trauma, and vitreous wicks, with virulent organisms impacting visual outcomes.

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Area of Science:

  • Ophthalmology
  • Infectious Diseases

Background:

  • Late onset endophthalmitis presents a diagnostic challenge, particularly when occurring long after initial ocular surgery.
  • Glaucoma surgery filtering blebs are potential sites for delayed intraocular infections.

Purpose of the Study:

  • To investigate the association between late onset endophthalmitis and glaucoma surgery filtering blebs.
  • To identify predisposing factors and causative organisms in these cases.

Main Methods:

  • Retrospective review of 71 consecutive cases of late onset endophthalmitis (onset ≥ 2 weeks post-surgery).
  • Analysis of surgical history, predisposing factors, microbial cultures, and visual outcomes.

Main Results:

  • Sixteen cases were linked to filtering blebs, and two to inadvertent blebs after cataract surgery.

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  • Onset ranged from 24 days to 20 years post-surgery (mean 6.9 years).
  • Common pathogens included Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus, and Pseudomonas.

    • Conclusions:

    • Glaucoma surgery filtering blebs are a significant risk factor for late onset endophthalmitis.
    • Trauma, vitreous wicks, and bleb leaks may contribute to infection development.
    • Virulent organisms correlate with poorer visual prognosis.