BLEBITIS, EARLY ENDOPHTHALMITIS, AND LATE ENDOPHTHALMITIS AFTER GLAUCOMA-FILTERING SURGERY

Purpose: The differentiating characteristics in blebitis and early and late endophthalmitis after glaucoma filtration surgery are reviewed. Methods: All admission records and operative reports, as well as avail able office notes, on patients with blebitis or bleb-associated endoph thalmitis admitted to a large referral eye center from 1985 to 1995 we re reviewed retrospectively. Results: Ten cases of blebitis and 33 cas es of bleb-associated endophthalmitis were identified, One patient wit h blebitis progressed to culture-positive endophthalmitis. Of the 33 c ases of bleb-associated endophthalmitis, there were 6 cases of early e ndophthalmitis (before postoperative week 6) and 27 cases of late endo phthalmitis. In early endophthalmitis, Staphylococcus epidermidis was isolated on vitreous culture in 4 (67%) of 6 cases, whereas in late en dophthalmitis, this organism was isolated in only 1 (4%) of 27 cases. in the 27 late cases, Streptococcus species and gram-negative organism s comprised 48% of isolates; of 33 cases of endophthalmitis, 15 (45%) demonstrated no growth on vitreous culture. Patients with endophthalmi tis fared more poorly than those with blebitis in terms of visual outc ome. Conclusions: Because blebitis may be prodromal to endophthalmitis , aggressive antimicrobial therapy, perhaps with oral quinolones, is w arranted, In addition, patients with blebitis should be observed close ly to identify extension into the vitreous cavity so that intravitreou s antibiotics can be administered in a timely fashion. Finally, clinic ians should not extrapolate the results of the Endophthalmitis Vitrect omy Study to the postfiltration surgery endophthalmitis given the diff ering pathogenesis and unique spectrum of organisms.