Blebitis, early endophthalmitis, and late endophthalmitis after glaucoma-filtering surgery.
OBJECTIVE
The differentiating characteristics in blebitis and early and late endophthalmitis after glaucoma filtration surgery are reviewed.


METHODS
All admission records and operative reports, as well as available office notes, on patients with blebitis or bleb-associated endophthalmitis admitted to a large referral eye center from 1985 to 1995 were reviewed retrospectively.


RESULTS
Ten cases of blebitis and 33 cases of bleb-associated endophthalmitis were identified. One patient with blebitis progressed to culture-positive endophthalmitis. Of the 33 cases of bleb-associated endophthalmitis, there were 6 cases of early endophthalmitis (before postoperative week 6) and 27 cases of late endophthalmitis. In early endophthalmitis, Staphylococcus epidermidis was isolated on vitreous culture in 4 (67%) of 6 cases, whereas in late endophthalmitis, this organism was isolated in only 1 (4%) of 27 cases. In the 27 late cases, Streptococcus species and gram-negative organisms comprised 48% of isolates; of 33 cases of endophthalmitis, 15 (45%) demonstrated no growth on vitreous culture. Patients with endophthalmitis fared more poorly than those with blebitis in terms of visual outcome.


CONCLUSIONS
Because blebitis may be prodromal to endophthalmitis, aggressive antimicrobial therapy, perhaps with oral quinolones, is warranted. In addition, patients with blebitis should be observed closely to identify extension into the vitreous cavity so that intravitreous antibiotics can be administered in a timely fashion. Finally, clinicians should not extrapolate the results of the Endophthalmitis Vitrectomy Study to the postfiltration surgery endophthalmitis given the differing pathogenesis and unique spectrum of organisms.
Ciulla
T A
TA
Department of Ophthalmology, Indiana University School of Medicine, Indianapolis 46202-5175, USA.
Beck
A D
AD
Topping
T M
TM
Baker
A S
AS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D001082:Aqueous Humor / Q000382:microbiology; D003228:Conjunctiva / Q000382:microbiology; D004359:Drug Therapy, Combination / Q000008:administration & dosage / Q000627:therapeutic use; D009877:Endophthalmitis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D018463:Filtering Surgery / Q000009:adverse effects*; D005902:Glaucoma, Open-Angle / Q000601:surgery*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D013210:Staphylococcus / Q000302:isolation & purification; D014822:Vitreous Body / Q000382:microbiology
D000900:Anti-Bacterial Agents; D005938:Glucocorticoids