Clinical analysis of infectious endophthalmitis following glaucoma filtration surgery

Liangliang Niu; Yan Luo; Huan Xu; Haili Huang; Rui Jiang; Xinghuai Sun

doi:10.1186/s12348-024-00391-4

Clinical analysis of infectious endophthalmitis following glaucoma filtration surgery

J Ophthalmic Inflamm Infect. 2024 Feb 29;14(1):11. doi: 10.1186/s12348-024-00391-4.

Authors

Liangliang Niu^#¹, Yan Luo^#², Huan Xu¹, Haili Huang¹, Rui Jiang^{3

4}, Xinghuai Sun^{5

6

7}

Affiliations

¹ Department of Ophthalmology & Visual Science, Eye Institute, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China.
² Hospital-Acquired Infection Control Department, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China.
³ Department of Ophthalmology & Visual Science, Eye Institute, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China. 2jiang@163.com.
⁴ Ocular Trauma Center, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China. 2jiang@163.com.
⁵ Department of Ophthalmology & Visual Science, Eye Institute, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China. xhsun@shmu.edu.cn.
⁶ NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, 200031, China. xhsun@shmu.edu.cn.
⁷ State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China. xhsun@shmu.edu.cn.

^# Contributed equally.

Abstract

Background: This study aimed to evaluate the clinical correlative factors and outcomes of treatment of bleb-associated endophthalmitis (BAE) following glaucoma filtration surgery in a Chinese population from the year 2012 to 2022, and to compare them with the clinical course during the coronavirus disease (COVID-19) pandemic period.

Methods: This was a retrospective analysis of consecutive cases of BAE treated at the Eye & ENT Hospital of Fudan University, Shanghai, China, between January 1, 2012, and December 31, 2022. The clinical presentation, treatment modality, microbiological data, clinical course, and outcomes of visual acuity (VA) and intraocular pressure (IOP) in all BAE cases were collected and analyzed.

Results: A total of 28 eyes with BAE were examined, predominantly in male patients (71.4%, p = 0.023). Most patients underwent trabeculectomy (89.3%, p ≤ 0.001), while a smaller proportion underwent Ex-PRESS implantation (10.7%). Primary open-angle glaucoma (POAG) was the most common type of glaucoma (39.3%, p ≤ 0.001). Most patients (96.4%) presented with poor visual acuity, worse than 20/400, and IOP ranged from 3-60 mmHg. Treatment, including initial tap-and-inject procedure of antibiotics (Ceftazidime and Norvancomycin) or initial pars plana vitrectomy (PPV), was initiated 5.0 ± 7.1 days after BAE onset. Streptococcus was the most common causative organism (53.6% of cases, p ≤ 0.001). The visual acuity significantly improved from 2.58 ± 0.27 to 2.14 ± 0.85 (reported in logMAR) after treatment (p ≤ 0.001), and most patients maintained normal tension during follow-up. Poisson regression model analysis showed the annual incidence of BAE during the COVID-19 pandemic period was significantly twice greater than that of previous years.

Conclusions: BAE may cause irreversible visual impairment. POAG filtering surgery with male sex and the COVID-19 pandemic period might be potentially relevant factors for BAE. Culture positivity was closely related to BAE prognosis, with Streptococcus species being the leading pathogenic organisms. Online outpatient services, early diagnosis, and timely treatment may rescue vision and maintain IOP control in the presence of BAE.

Keywords: Bleb; COVID-19 pandemic; Endophthalmitis; Glaucoma.

Abstract

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