ENDOPHTHALMITIS AFTER FILTERING SURGERY WITH MITOMYCIN

Objective: To identify the incidence, causative organisms, and clinica l outcomes of eyes with bleb-associated endophthalmitis after glaucoma filtering procedures with adjunctive mitomycin. Methods: Retrospectiv e analysis of 773 consecutive eyes that underwent glaucoma filtering s urgery at the Bascom Palmer Eye Institute, Miami, Fla. The course of 6 09 eyes from 485 patients with a minimum of 3 months of follow-up were reviewed. Results: Mean follow-up was 16.0+/-11.5 months (range, 3-48 months). Of the 609 eyes, 13 (2.1%) developed bleb-associated endopht halmitis an average of 18.5+/-13.2 months after surgery (range, 1-45 m onths). The incidence of bleb-associated endophthalmitis was significa ntly greater after inferior trabeculectomy (7.8% per patient-year) tha n after superior trabeculectomy (1.3% per patient-year) by Kaplan-Meie r estimates (P=.02, log rank test). The cumulative incidence was 13% f or inferior limbal blebs and 1.6% for superior limbal blebs. Nine (69. 2%) of the 13 eyes were culture positive. Streptococcus sanguis and Ha emophilus influenzae (6/13 [46.2%]) were the most frequent causative o rganisms. The mean increase in intraocular pressure after endophthalmi tis treatment was 1.2 mm Hg, with a mean decrease in visual acuity of 1.42 logMAR units. Eight (61.5%) of the 13 eyes had a final acuity of 20/400 or better. Conclusions: The incidence of bleb-associated endoph thalmitis after guarded filtering surgery performed with adjunctive mi tomycin is higher than the reported rate in eyes undergoing filtering surgery without the use of antifibrotic agents (0.2%-1.5%). Inferior l imbal trabeculectomy carries the highest risk of infection. Eyes with mitomycin blebs maintained excellent filtration capacity. However, aft er treatment of the infection, the visual outcomes were generally poor .