Comparative Outcomes of Endophthalmitis in Trabeculectomy and Tube Shunt Surgery: A Nine-Year Review of Clinical Course and Management.

PURPOSE: To describe the management patterns and outcomes among patients with incisional glaucoma surgery-associated endophthalmitis.

METHODS

Retrospective review of all patients treated for endophthalmitis following standalone incisional glaucoma surgery (trabeculectomy and glaucoma drainage device (GDD) implants at a single institution). Data were recorded on clinical course, microbiological findings, management, and treatment outcomes.

RESULTS

A total of 101 eyes with incisional glaucoma surgery-related endophthalmitis were identified, of which 66% (N = 67/101) were trabeculectomy related. The mean (SD) time from surgery to endophthalmitis presentation was 4.9 (6.3) years for trabeculectomies and 3.6 (4.5) years for GDD implant surgery. Most (N = 98/101, 97%) eyes underwent initial treatment with intravitreal antibiotics alone. Of the 98 eyes undergoing initial treatment with intravitreal antibiotics, 14% (N = 14/98) underwent a repeat injection of antibiotics, and 16% (N = 16/98) underwent a subsequent PPV after initial treatment. A higher proportion of eyes with GDD-related endophthalmitis underwent repeat injection with intravitreal antibiotics compared to eyes with trabeculectomy-related endophthalmitis (23.5% vs 9.0%, p = 0.045). The overall culture-positive rate was 30% (N = 26/85), with gram-positive microorganisms being more common. The mean presenting logMAR VA was 2.36 (Snellen equivalent 20/4600). Mean logMAR VA at last follow-up was 1.90 (Snellen equivalent 20/1600), with a mean (SD) follow-up duration of 2.6 (2.8) years.

CONCLUSIONS

Visual outcomes following incisional glaucoma surgery-associated endophthalmitis remain guarded. Most patients were managed with intravitreal antibiotics alone. Eyes with GDD-related endophthalmitis may be more likely to undergo repeat injection of intravitreal antibiotics.