Delayed-Onset Bleb-Associated Endophthalmitis (1996–2008)

Leng, Theodore; Miller, Darlene; Flynn, Harry W.; Jacobs, David J.; Gedde, Steven J.

doi:10.1097/iae.0b013e3181e09810

Cited by 80 publications

(71 citation statements)

References 32 publications

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“…However, there is controversy over the degree of risk that age confers; some report a tendency for younger patients (<60 years of age) to develop BRI,4,6,9,12,24 while others display a noticeably older distribution 1,16,18,25. Our study supports the latter trend with BRE subjects being on average 10.7 years older than the blebitis group ( P =0.026).…”

Section: Discussionsupporting

confidence: 76%

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

Yap¹,

Chin²,

Ku³

et al. 2016

OPTH

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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.

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Section: Discussionsupporting

confidence: 76%

“…in the US and East Asia, respectively 9,10,18,19,25,27,30. Almost half of our patients with BRIs were culture negative.…”

Section: Discussionmentioning

confidence: 76%

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

Yap¹,

Chin²,

Ku³

et al. 2016

OPTH

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“…Delayed-onset bleb-related endophthalmitis is also associated with a disproportionately higher rate of Streptococcal infection. This may be the result of alterations in the resident flora or structural changes in the eye wall, and such changes may also occur in some eyes after multiple intravitreal injections [30, 84–86]. …”

Section: Reviewmentioning

confidence: 99%

Endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injection: a comprehensive review

Merani

Hunyor

2015

Int J Retin Vitr

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The purpose of this review is to report and summarize previously reported studies and assess many of the individual steps of the intravitreal injection procedure’s possible effect on the prevention of endophthalmitis. The pooled endophthalmitis rate from 20 large retrospective case series of anti-VEGF injections was 144/510,396 (0.028%; 1/3,544). Injections may be performed in an office-based location or in an operating room (OR) and low rates of endophthalmitis can be achieved in either location with careful attention to asepsis. Pre- or post-injection topical antibiotics have not been shown to be effective, and could select for more virulent microorganisms. Povidone-iodine prior to injection is accepted as the gold-standard antiseptic agent, but aqueous chlorhexidine may be an alternative. Antisepsis before and after gel or subconjunctival anesthetic is suggested. The preponderance of Streptococcal infections after intravitreal injection is discussed, including the possible role of aerosolization, which can be minimized by using face masks or maintaining silence. As with other invasive procedures in medicine, the use of sterile gloves, following adequate hand antisepsis, may be considered. Control of the eyelashes and lid margin is required to avoid contamination of the needle, but this can be achieved with or without a speculum. Techniques to minimize vitreous reflux have not been shown to reduce the risk of endophthalmitis. Same day bilateral injections should be performed as two separate procedures, preferably using drug from different lots, especially when using compounded drugs.

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“…Exogenous endophthalmitis cases, caused by bacteria entering the eye from the exterior of the body, can occur following trauma or procedures such as cataract surgeries or surgeries necessitating corneal sutures1346. The most common bacteria isolated as causes of post-operative endophthalmitis are coagulase-negative staphylococci, Pseudomonas , and streptococcal species678. Culture-proven cases not necessarily linked to surgery include Staphylococcus aureus in addition to coagulase-negative staphylococci and viridans group streptococci9.…”

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confidence: 99%

Exogenous Streptococcus pneumoniae Endophthalmitis in Diabetic Rabbits

Benton

Fulton

Marquart

2017

Sci Rep

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Diabetics are at increased risk for eye infections including bacterial endophthalmitis. It is unclear whether the severity of endophthalmitis is greater in these patients due to confounding factors such as pre-existing ocular diseases in some but not others. Therefore, we tested the hypothesis that disease severity and/or bacterial loads would be significantly higher in a Type I diabetic rabbit model of Streptococcus pneumoniae endophthalmitis. Rabbits were treated with alloxan to destroy pancreatic islet cells, or mock-treated with vehicle, and maintained for 10 days before intravitreal infection with S. pneumoniae E353. Clinical scoring of the eyes was performed 24 and 48 hours after infection, followed by euthanasia and vitreous harvest to quantitate bacterial loads. There were no significant differences in clinical scores (P ≥ 0.440) or bacterial loads (P = 0.736), however, 4/12 (33%) of the diabetic rabbits became bacteremic. This finding not only indicates a breakdown in the blood-ocular barrier, but also prompts further investigation into the exploitation of the diabetic eye by the streptococci.

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Delayed-Onset Bleb-Associated Endophthalmitis (1996–2008)

Abstract: 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.

Cited by 80 publications

References 32 publications

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

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

Endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injection: a comprehensive review

Exogenous Streptococcus pneumoniae Endophthalmitis in Diabetic Rabbits

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