Early and Late Endophthalmitis following Trabeculectomy in a Chinese Population

Kuang, Tung-Mei; Lin, Yuan-Mao; Liu, C. Jui-Ling; Hsu, Wen-Ming; Chou, Chen Kung

doi:10.1177/112067210801800111

Cited by 26 publications

(22 citation statements)

References 18 publications

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“…Intraoperative 5-FC or MMC are recognised as important risk factors for bleb-related infection 22 51 75. A Cochrane review concluded that intraoperative MMC reduced the risk of surgical failure, but complications such as infection could not be evaluated due to inadequate power 76.…”

Section: Discussionmentioning

confidence: 99%

Postoperative infection in penetrating versus non-penetrating glaucoma surgery

Ang

Varga

Shaarawy

2009

British Journal of Ophthalmology

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The aim of glaucoma surgery is to lower the intraocular pressure in order to reduce the risk of further glaucomatous progression, particularly in cases refractory to topical therapy. Although effective in reducing intraocular pressure, these procedures are not without complications, with endophthalmitis being one of the most serious. A PubMed review of the literature was performed for trabeculectomy, glaucoma drainage device procedures (Ahmed, Baerveldt and Molteno implants) and non-penetrating glaucoma surgery (deep sclerectomy and viscocanalostomy) for reports of postoperative infection, including blebitis and endophthalmitis. The literature on infections relating to non-penetrating glaucoma surgery is sparse compared with penetrating surgery, but this may be a reflection of the relatively shorter follow-up duration and comparatively smaller body of data available on non-penetrating procedures. Overall, there is not enough evidence, in terms of well-constructed randomised clinical trials with sufficiently large sample sizes and long follow-up durations, to be able to make informed comparisons of the risk of postoperative endophthalmitis and infection between the various glaucoma operations. This review article summarises the incidences of endophthalmitis from the literature and discusses the major risk factors for postoperative infection.

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Section: Discussionmentioning

confidence: 99%

Postoperative infection in penetrating versus non-penetrating glaucoma surgery

Ang

Varga

Shaarawy

2009

British Journal of Ophthalmology

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“…At the Singapore National Eye Centre, all trabeculectomies are performed with adjunctive anti-fibrotic agents, MMC being the preferred choice. Rates of BRE after using MMC have been reported at 1.1%–3.2% 2,4,15,16. While Mochizuki et al’s study demonstrated similar BRI rates of 1.3% and 1.1% with 5-FU and MMC, respectively 4.…”

Section: Introductionmentioning

confidence: 94%

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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“…Kuang et al . [9] in a retrospective study reported only one case, out of 988 trabeculectomies, with early post-operative endophthalmitis due to Morganella morganii . Host flora is usually responsible for early cases of endophthalmitis and Staphylococcus epidermitis is the most common organism.…”

Section: Discussionmentioning

confidence: 99%

Acute onset lactobacillus endophthalmitis after trabeculectomy: a case report

et al. 2010

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IntroductionWe report a case of early lactobacillus endophthalmitis which occurred ten days after trabeculectomy.Case presentationA 76-year-old Caucasian diabetic woman underwent uncomplicated trabeculectomy with a collagen implant as an adjunct, in her left phakic eye, for the treatment of uncontrolled open-angle glaucoma. Ten days post-operatively, our patient complained of left phakic eye discharge pain and visual acuity decreased to "light-perception". The anterior chamber had 3+ cells and flare, and there was also 2 mm layered hypopyon. Vitreous involvement was present obscuring visualization of the fundus. On the same day our patient underwent vitrectomy surgery and intra-vitreal and systemic antibiotics were administered. Vitreous cultures grew Lactobacillus brevis. Our patient responded well to treatment and 30 days after vitrectomy visual acuity improved to 1/10. Six months later our patient underwent cataract surgery. Eight months after initial surgery visual acuity was 2/10 and intra-ocular pressure was 14 mmHg without any anti-glaucoma medication.ConclusionsThis is the first report of acute lactobacillus endophthalmitis in the phakic eye of a diabetic patient after trabeculectomy. Glaucoma surgeons should be aware of the potential for acute post-operative endophthalmitis due to rare microorganisms, such as lactobacillus, in glaucoma filtration surgery, especially in diabetic patients. The literature shows an increased risk of endophthalmitis when anti-metabolites are used in conjunction with trabeculectomy. Perhaps, any type of wound healing modulation, such as collagen or mitomycin-C may increase this risk. However, it is unclear at this time and more studies need to be done. In this single case, vitrectomy combined with intra-vitreal and systemic antibiotics were efficient in limiting the devastating sequels of this complication.

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Early and Late Endophthalmitis following Trabeculectomy in a Chinese Population

Abstract: Physicians should weigh the benefits against the risks of mitomycin C application in performing trabeculectomies.

Cited by 26 publications

References 18 publications

Postoperative infection in penetrating versus non-penetrating glaucoma surgery

Postoperative infection in penetrating versus non-penetrating glaucoma surgery

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

Acute onset lactobacillus endophthalmitis after trabeculectomy: a case report

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