Bleb-associated endophthalmitis: Clinical characteristics and visual outcomes

Purpose To analyze the clinical characteristics and treatment outcomes of patients with bleb-associated endophthalmitis (BAE). Design Retrospective, noncomparative, interventional case series. Participants Consecutive patients treated at one institution for BAE. Interventions Prompt pars plana vitrectomy (PPV) with intravitreal injection of antibiotics, or prompt vitreous biopsy and intravitreal injection of antibiotics (tap and inject). Methods Retrospective analysis of 68 consecutive cases of BAE between July 1, 1989 and June 30, 2001. Clinical presentation, treatment modality, microbiologic data, and clinical course were analyzed. Visual outcomes were compared between vitrectomy and tap-and-inject groups, culture-positive and culture-negative groups, and early and late times. Main outcome measures Snellen visual acuities (VAs) at 3 months and 12 months after treatment and at most recent follow-up. Results The incidence of no light perception (NLP) at 12 months after treatment for BAE was 35%. Vitreous isolates included streptococcal species (32% of positive cultures), Staphylococcus epidermidis (26%), Enterococcus, and Serratia (12% each). Patients with a positive vitreous culture had significantly worse VA (median, hand movements [HM] at 3 and 12 months after treatment) and a higher rate of NLP vision. Patients treated with tap-and-inject had a significantly worse final VA (medians, HM at 3 months and LP at 12 months) and a significantly higher rate of NLP vision than patients treated with PPV. One third of patients who underwent PPV achieved a final VA of 20/100 or better 12 months after treatment (P = 0.09). Conclusions Bleb-associated endophthalmitis causes significant visual morbidity. Patients with culture-negative BAE and patients treated with prompt PPV may achieve better visual outcome.