Bleb related infections: clinical characteristics, risk factors, and outcomes in an Asian population

Abstract

PurposeComparison of the demographic, ocular, systemic and microbiological characteristics of eyes with bleb related infection (BRI) and bleb related endophthalmitis (BRE).MethodsRetrospective chart review of patients with BRI from January 1996–July 2013. Identification done via the center’s longstanding endophthalmitis audit, BRI audit and laboratory database identifying all conjunctival swabs from blebs. Blebitis was defined as anterior segment inflammation with mucopurulent material in or around the bleb, with anterior chamber cells but no hypopyon. BRE was defined by the presence of hypopyon or vitreous inflammation.ResultsTwenty-nine patients with blebitis and 10 with BRE were identified. Mean age of subjects (n=39) was 68.4 (±13.3) with a preponderance of men (74.4%) and Chinese ethnicity (74.4%). BRE patients were 10.7 years older than blebitis patients (P=0.026). 28 (71.8%) subjects had primary open angle glaucoma. The presenting intraocular pressure (IOP) dropped in blebitis but almost doubled in BRE (P=0.011) compared to average preinfective IOP. Two weeks after treatment, IOPs in both groups returned to close to preinfective levels. Subjects with blebitis more often had an avascular bleb (88.0%) while those with BRE trended toward a moderately vascular bleb (50%). The distribution of causative microorganisms between the groups was similar.ConclusionOur study indicates that risk factors are similar in both groups even though the visual outcome and clinical course, in the form of IOP findings and bleb vascularity, can diverge significantly. The decreased IOP in blebitis subjects represents objective evidence of subclinical leaks or bleb sweating.

Bleb-Related Endophthalmitis: A 15-Year Review

“…Microbiologic workup via obtaining cultures and sensitivities is a standard part of treatment. However, there is often a high rate of culture-negative samples (21%-86%), 1,20 as seen in our study in which 44% were negative. One report summarizing bleb-related infections in Japan noted almost a 50% yield in bacterial cultures.…”

“…Although regional differences may exist regarding causative organisms, the most common pathogens in many reports are Staphylococcus or Streptococcus species. 1,8,10,13,19,20 This was reflected in our cohort of patients in which 75% of positive cultures were Staphylococcus or Streptococcus species. Patients with late-onset, bleb-related infections were found to be infected with more-virulent organisms such as aggressive Streptococcus and gram-negative organisms, 11 and therefore were thought to have poorer visual outcomes.…”

Infectious Endophthalmitis: Trends in Microbiology, Management, and Surgical Techniques

“…27 This belief is strengthened by the observation that causative microorganisms are similar between BRE and blebitis. 28 Risk factors for endophthalmitis following GDIs include implant exposure and recent surgery. 29 Additional risk factors for any BRI include pigmentary glaucoma, juvenile glaucoma, bleb leak, sustained low IOP, chronic blepharitis, and punctual plugs.…”

“…27 This belief is strengthened by the observation that causative microorganisms are similar between BRE and blebitis. 28…”

A Case Series Demonstrating a Novel Technique for Reversal of Trabeculectomy Using Lamellar Sclerectomy and Corneal Graft

“…Despite the overall success and prevalence of trabeculectomy, the surgery confers numerous potentially severe short- and long-term complications, including diplopia 1 and motility disturbances, 2 hypotony, dysesthesia, and endophthalmitis. 3 A variety of techniques have been developed to manage trabeculectomy-related complications and preserve trabeculectomy function. However, in certain circumstances a trabeculectomy reversal may be preferable to revision.…”