Late-Onset Endophthalmitis Associated with Glaucoma Surgery

ABSTRACT

PURPOSE: To report cases of late-onset endophthalmitis associated with glaucoma surgery. METHODS: We retrospectively reviewed the medical records of 4905 consecutive patients who underwent glaucoma surgery (trabeculectomy or valve implant surgery) from January 1, 1988 to March 31, 2013. RESULTS: There were a total of 14 late-onset endophthalmitis (0.29%) cases associated with glaucoma surgery occurring at 1 year to 21 years postoperatively. Six cases (6/993, 0.60%) occurred after valve implantation and the other 8 cases (8/3912, 0.20%) occurred after trabeculectomy (p = 0.046). All but one patient were injected with fortified vancomycin and ceftazidim. Four patients also received a vitrectomy with the injection. The implanted valve was removed in 2 cases. In four cases, organisms were found in the culture (staphylococcus.aureus, streptococcus viridians, propionibacterium acnes and candida parapsilosis). After 1 year, only 4 patients achieved a visual acuity above 4/200 compared with other patients who had a final visual acuity of hand motion or worse. Three patients (33%) who developed endophthalmitis underwent other intraocular procedures. CONCLUSIONS: Late-onset endophthalmitis associated with glaucoma surgery can often occur with fulminant sight-threatening complications. Due to devastating sequelae, the surgeon should carefully check the surgery site in the patients who underwent glaucoma surgery at every follow-up visit. Delayed endophthalmitis after glaucoma surgery still carries a poor visual prognosis and its onset is difficult to predict. Therefore, patients who undergo glaucoma surgery should be educated and carefully evaluated during regular follow-ups.