Microbiology and Visual Outcome of Bleb-associated Endophthalmitis

Al‐Turki, Turki A.; Al-Shahwan, Sami; Al-Mezaine, Hani S.; Kangave, Dustan; El‐Asrar, Ahmed M. Abu

doi:10.3109/09273940903370730

Cited by 34 publications

(36 citation statements)

References 19 publications

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“…Higher prevalence of Streptococcus species during the late onset of bleb-associated endophthalmitis have also been reported. [561819] Whereas, in the present study, the prevalence of Streptococcus species accounting to 75% in the early onset group of blebitis were associated with dacryocystitis and releasable sutures in those nasolacrimal ducts were obstructed. Thus, it seems that the higher prevalence of Streptococcus species in the early onset of blebitis is due to the presence of nasolacrimal duct obstruction in these cases.…”

Section: Discussioncontrasting

confidence: 56%

“…[12] Bleb infections are mainly caused by resident and transient flora, of which Streptococcus species was found to be the commonest cause for bleb-associated infections. [56] Considering the importance of blebitis as a cause for intraocular infection, a proper understanding of the risk factors predisposing to blebitis and causative microbial agents are a must for early recognition and prevention of endophthalmitis. This study delineates the microbial etiology and risk factors in patients with blebitis who underwent incisional glaucoma surgery at a tertiary eye care referral center in South India.…”

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confidence: 99%

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Etiology and epidemiological analysis of glaucoma-filtering bleb infections in a tertiary eye care hospital in south India

Ramakrishnan

Bharathi

Maheshwari

et al. 2011

Indian J Ophthalmol

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Purpose:To evaluate the microbial etiology and associated risk factors among patients with blebitis following trabeculectomy.Materials and Methods:A retrospective analysis of all culture-proven blebitis was performed in patients who underwent trabeculectomy between January 2004 and December 2008. A standardized form was filled out for each patient, documenting sociodemographic features and information pertaining to risk factors. Swabbing of the infected bleb surface was performed for all suspected cases and further subjected to microbiological analysis.Results:A total of 23 patients with culture-proven blebitis were treated during the study period, with a mean age of 59.2 years (59.2 ± SD: 12.8; range, 30-81 years). Duration of onset was early (≤36 months) in six (26%) cases and late (> 36 months) in 17 (74%) cases with a range between 15 and 144 months (mean, 82.91 months; SD: 41.89). All 23 blebs were located superiorly and of which, 21 (91%) were microcystic avascular, 1 (4%) diffuse avascular, and 1 (4%) vascular flattened. The predominant risk factor identified was bleb leak (35%; 8 of 23) followed by thin bleb (22%; 5 of 23) and blepharitis (17%; 4 of 23). Bleb leaks (100%) were recorded only in patients with late onset (≥ 9 years) of infection (P< 0.001), while the incidence of ocular surface disease (100%) occurred early (≤3 years) (P< 0.001). Use of topical steroids was associated frequently with cases of thin blebs (80%; 4 of 5) (P< 0.001), while topical antibiotics showed bleb leaks (88%; 7 of 8) (P< 0.001). Coagulase-positive staphylococci were frequently recovered from blebitis with thin blebs (71%; 5 of 7) (P = 0.001), Coagulase-negative staphylococci (CoNS) with bleb leak (100%; 8 of 8) (P< 0.001), Corynebacterium with blepharitis (100%; 3 of 3) (P = 0.001), and Streptococci with releasable sutures (75%; 3 of 4) (P = 0.001).ConclusionBleb leak is the principal risk factor responsible for late-onset blebitis, while early-onset blebitis could be ascribed to ocular surface diseases. Streptococci were mainly responsible for early onset of infection, while the late onset was due to CoNS.

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Section: Discussioncontrasting

confidence: 56%

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confidence: 99%

Etiology and epidemiological analysis of glaucoma-filtering bleb infections in a tertiary eye care hospital in south India

Ramakrishnan

Bharathi

Maheshwari

et al. 2011

Indian J Ophthalmol

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“…Staphylococcus epidermidis is one of the most common pathogens [11]. Bacterial endophthalmitis often causes serious damage to visual function.…”

Section: Discussionmentioning

confidence: 99%

Antiinflammatory effect of low-level laser therapy on Staphylococcus epidermidis endophthalmitis in rabbits

et al. 2011

Lasers Med Sci

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A rabbit model of endophthalmitis was established to evaluate the antiinflammatory effect of low-level laser therapy (LLLT) as an adjunct to treatment for Staphylococcus epidermidis endophthalmitis. Rabbits were randomly divided into three groups to receive intravitreal injections into their left eye: group A received 0.5 mg vancomycin (100 μl), group B received 0.5 mg vancomycin + 0.2 mg dexamethasone (100 μl), and group C received 0.5 mg vancomycin (100 μl) and continuous wave semiconductor laser irradiation (10 mW, λ = 632 nm) focused on the pupil. Slit lamp examination and B-mode ultrasonography were conducted to evaluate the symptoms of endophthalmitis. Polymorphonuclear cells and tumour necrosis factor alpha (TNF-α) in aqueous fluid were measured at 0 h, and 1, 2, 3, 7 and 15 days. A histology test was conducted at 15 days. B-mode ultrasonography and histology revealed that groups B and C had less inflammation than group A at 15 days. Groups B and C had fewer polymorphonuclear cells and lower levels of TNF-α in aqueous fluid than group A at 2, 3 and 7 days (P < 0.05). There was no significant difference between groups B and C (P > 0.05). There was no significant difference between groups A, B and C at 15 days (P > 0.05). As an adjunct to vancomycin therapy to treat S. epidermidis endophthalmitis, LLLT has an antiinflammatory effect similar to that of dexamethasone.

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“…Small case series of post-bleb endophthalmitis with and without shunt devices seemed to suggest that pneumococcus is more prevalent in children than in adults. 9,14,15 Of interest is the inclusion of the S. pneumoniae serotype 19A in the 13-valent pneumococcal vaccine 16 ; this patient received three doses of the 7-valent conjugated pneumonococcal vaccine in infancy and was due to receive the 13-valent vaccine, which was incorporated in July 2010 in the provincial immunization schedule, at his preschool vaccination in 2012. 17 Following the patient's course of intravenous vancomycin and oral levofloxacin, the patient improved significantly with respect to the orbital reaction as well as decreased inflammation in the anterior chamber and marked clearing of the corneal haze.…”

Section: Discussionmentioning

confidence: 99%

Concurrent endophthalmitis and orbital cellulitis in a child with congenital glaucoma and a glaucoma drainage device

Kassam¹,

Lee²,

Damji³

2011

Digit J Ophthalmol

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SummaryA 3-year-old monocular boy with a history of congenital glaucoma and aqueous shunt implantation presented with periorbital swelling, erythema, and purulent discharge in his seeing right eye. Examination revealed an extensive hypopyon. Computed tomography (CT) showed right-sided proptosis, and a displaced aqueous shunt device deep in the orbit. Significant purulent fluid was encountered when the device was removed; vitreous and orbital cultures revealed Streptococcus pneumoniae. The patient received intravitreal, topical, intravenous, and oral antibiotics as well as intraocular tissue plasminogen activator and topical steroid. Orbital and intraocular inflammation decreased significantly but he developed a cataract, further complicated by a retinal detachment. Case ReportA 3-year-old monocular boy with a history of congenital glaucoma presented to the ophthalmology clinic at the Royal Alexandra Hospital in May 2011 with purulent discharge from his seeing right eye associated with periorbital swelling and erythema. The patient had a routine examination by his pediatric ophthalmologist 2 days prior. At the time, red reflex and retinoscopy streak in his right eye was noted to be clear, but the examination was lengthy and difficult and attempts at a slit-lamp examination were unsuccessful. He presented to the emergency room the next day complaining of severe pain behind the right eye with no obvious eyelid swelling. Examination was limited since he was unwilling to open the eye, and he was referred to the ophthalmology clinic the next day. The parents denied a history of the patient rubbing his eye.The family was of Turkish descent, and the patient's paternal and maternal grandfathers were distant relatives. The patient's older sister had also been diagnosed with congenital glaucoma and had received extensive treatment. Genetic testing found the patient to be autosomal recessive for the Cyp1B1 gene, which has been mapped to the 2p21 region and linked with primary congenital glaucoma. 1

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Microbiology and Visual Outcome of Bleb-associated Endophthalmitis

Cited by 34 publications

References 19 publications

Etiology and epidemiological analysis of glaucoma-filtering bleb infections in a tertiary eye care hospital in south India

Etiology and epidemiological analysis of glaucoma-filtering bleb infections in a tertiary eye care hospital in south India

Antiinflammatory effect of low-level laser therapy on Staphylococcus epidermidis endophthalmitis in rabbits

Concurrent endophthalmitis and orbital cellulitis in a child with congenital glaucoma and a glaucoma drainage device

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