J Korean Ophthalmol Soc.  2014 Nov;55(11):1651-1658. 10.3341/jkos.2014.55.11.1651.

Late-Onset Endophthalmitis Associated with Glaucoma Surgery

• Kim SY
• Rho YJ
• Kim SY

• KMID: 2216614
• DOI: http://doi.org/10.3341/jkos.2014.55.11.1651

Abstract

PURPOSE
To report cases of late-onset endophthalmitis associated with glaucoma surgery.
METHODS
We retrospectively reviewed the medical records of 4905 consecutive patients who underwent glaucoma surgery (trabeculectomy or valve implant surgery) from January 1, 1988 to March 31, 2013.
RESULTS
There were a total of 14 late-onset endophthalmitis (0.29%) cases associated with glaucoma surgery occurring at 1 year to 21 years postoperatively. Six cases (6/993, 0.60%) occurred after valve implantation and the other 8 cases (8/3912, 0.20%) occurred after trabeculectomy (p = 0.046). All but one patient were injected with fortified vancomycin and ceftazidim. Four patients also received a vitrectomy with the injection. The implanted valve was removed in 2 cases. In four cases, organisms were found in the culture (staphylococcus.aureus, streptococcus viridians, propionibacterium acnes and candida parapsilosis). After 1 year, only 4 patients achieved a visual acuity above 4/200 compared with other patients who had a final visual acuity of hand motion or worse. Three patients (33%) who developed endophthalmitis underwent other intraocular procedures.
CONCLUSIONS
Late-onset endophthalmitis associated with glaucoma surgery can often occur with fulminant sight-threatening complications. Due to devastating sequelae, the surgeon should carefully check the surgery site in the patients who underwent glaucoma surgery at every follow-up visit. Delayed endophthalmitis after glaucoma surgery still carries a poor visual prognosis and its onset is difficult to predict. Therefore, patients who undergo glaucoma surgery should be educated and carefully evaluated during regular follow-ups.

Keyword

Endophthalmitis; Glaucoma; Glaucoma surgery

MeSH Terms

Candida
Endophthalmitis*
Follow-Up Studies
Glaucoma*
Hand
Humans
Medical Records
Prognosis
Propionibacterium acnes
Retrospective Studies
Streptococcus
Trabeculectomy
Vancomycin
Visual Acuity
Vitrectomy
Vancomycin

Figure

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  Figure 1. Representative image of slit lamp photograph shows conjunctival injection and hypopyon (case 8).

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  Figure 2. Representative image of B-scan ultrasonograph shows posterior vitreous opacification and multiple abnormal vitreous spikes (case 8).

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  Figure 3. Representative images of slit lamp photograph shows markedly injected conjunctiva and thin, cystic bleb (case 4).

Reference

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