title: Delayed-onset bleb-associated endophthalmitis (1996-2008): causative organisms and visual acuity outcomes.
abstract: OBJECTIVE
  The purpose of this study was to report the clinical features, organisms, and outcomes of patients with delayed-onset bleb-associated endophthalmitis.
  
  
  METHODS
  Retrospective consecutive case series. Patients who were treated for delayed-onset bleb-associated endophthalmitis between January 1, 1996, and July 1, 2008, at a single institution were included. Information on visual acuities, clinical characteristics, causative organisms, and treatment outcomes were collected. Infections within 1 month of glaucoma filtering surgery, inadvertent filtering blebs after cataract surgery, and patients with glaucoma drainage devices were excluded.
  
  
  RESULTS
  A total of 71 eyes from 68 patients were identified. An adjunctive antifibrotic agent was used in 48 eyes (68%). The mean time between surgery and endophthalmitis was 4.8 years (range, 0.1-16; standard deviation, 3.6). The average follow-up time after initial treatment was 37 months (range 1-144; standard deviation, 41). At presentation, 17 eyes (24%) had a bleb leak. Fifty-seven eyes (83%) were culture positive. The most common causative organisms were Streptococcus species in 20 eyes (30%), gram-negative organisms in 19 eyes (28%), and coagulase-negative Staphylococcus in 12 eyes (18%). All gram-positive isolates were sensitive to vancomycin. Nine eyes (13%) eventually underwent evisceration or enucleation secondary to pain and/or poor vision. The main outcome measure was best-corrected visual acuity at the last follow-up examination. Final visual acuities in the initial tap/inject group (n = 45) versus the initial vitrectomy group (n = 24) were as follows: ≥ 20/40 (29% vs. 4.2%), 20/50 to 20/400 (36% vs. 29%), and <5/200 (36% vs. 62%).
  
  
  CONCLUSIONS
  Streptococcus species and gram-negative organisms were the most common causative isolates identified in this case series of delayed-onset bleb-associated endophthalmitis. Despite treatment of the infection, visual outcomes were generally poor.
authors.affiliation: Department of Ophthalmology, Stanford University School of Medicine, Stanford, California 94025, USA. tedleng@stanford.edu
authors.forename: Theodore
authors.initials: T
authors.lastname: Leng
authors.forename: Darlene
authors.initials: D
authors.lastname: Miller
authors.forename: Harry W
authors.initials: HW
authors.lastname: Flynn
authors.forename: David J
authors.initials: DJ
authors.lastname: Jacobs
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Gedde
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001419:Bacteria / Q000302:isolation & purification; D009877:Endophthalmitis / Q000382:microbiology* / Q000503:physiopathology / Q000628:therapy; D015818:Eye Infections, Bacterial / Q000382:microbiology* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D018463:Filtering Surgery; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019738:Surgically-Created Structures; D014792:Visual Acuity / Q000502:physiology*; D014821:Vitrectomy
chemical_list: D000900:Anti-Bacterial Agents