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2001 Ocular Microbiology and Immunology Group, Abstract 8

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Delayed-Onset Bleb-Associated Endophthalmitis: Clinical Features and Visual Acuity Outcomes
A. Song, I.U. Scott, H.W. Flynn, Jr. and D.L. Budenz
Bascom Palmer Eye Institute, University of Miami, Miami FL.

Purpose: To investigate clinical factors, causative organisms, treatments, and visual acuity and intracular pressure outcomes associated with delayed-onset, bleb-associated endophthalmitis.

Methods: Retrospective, noncomparative, consecutive series of patients treated for bleb-associated endophthalmitis at Bascom Palmer Eye Institute between January 1996 and December 1999.

Results: An antifibrotic agent had been used in 27 (79%) of the 34 patients identified, including mitomycin C in 23 (68%) and 5-fluorouracil (5-FU) in 4 (12%). The mean interval between filtering surgery and endophthalmitis diagnosis was 4.2 years. The mean follow-up time after treatment for endophthalmitis was 4.4 months. Potential risk factors and clinical features among the study population include bleb leak in 8 (24%) eyes, bleb manipula-tions in 10 (29%) [needling in 3 (9%), compression sutures in 2 (6%), laser suture lysis in 5 (15%), bleb revision in 4 (12%), and autologous blood injection in 2 (6%)], bleb defects in 2 (6%),and inferior bleb location in 3 (9%), The most common causative organisms were Streptococcus species in 14 eyes (41%) and Staphylococcus species in 6 eyes (18%). Final visual acuities in the vitrectomy group (n=15) versus the initial tap group (n=18) were as follows: $20/40 (7% versus 17%), $20/400 (33% versus 72%), and >5/200 (67% versus 28%). Ten (29%) patients eventually underwent enucleation or evisceration secondary to pain and/or poor vision (light perception to no light perception). In three (12%) of the 24 eyes not enucleated, intraocular pressures were uncontrolled (>21 mm Hg) after treatment of endophthalmitis. Complete or partial collapse of the bleb was noted in seven cases.

Conclusions: Streptococcus species and Staphylococcus species were the most common causative organisms in this series of patients with delayed-onset bleb-associated endophthalmitis. Despite successful treatment of infection, visual outcomes are generally poor.

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