The authors evaluate visual and anatomical outcomes in a retrospective case series of 15 eyes from 15 patients treated for delayed-onset endophthalmitis following incisional glaucoma surgery. The study included patients presenting at a tertiary referral centre between 2013 and 2023 with infections occurring at a median interval of 5.2 years after trabeculectomy or glaucoma drainage device (GDD) implantation. Baseline visual acuity was severely compromised, with 14 eyes presenting with hand-motion vision. All cases were managed with prompt 23-gauge pars plana vitrectomy (PPV) within 24 hours of diagnosis, combined with intraocular antibiotics and silicone oil tamponade in every eye. Adjunctive source-control procedures, including bleb excision or GDD explanation, were performed when clinically indicated. Microbiological cultures yielded positive growth in 8 cases, identifying organisms such as Streptococcus species, Moraxella species and Staphylococcus aureus. At 6 months, median best-corrected visual acuity improved significantly from 3.01logMAR to 1.70logMAR, with 10 eyes achieving an improvement of at least 1.0logMAR. Anatomical success was achieved in all eyes, with no cases progressing to no-light-perception vision, phthisis bulbi or requiring enucleation. Postoperative complications were manageable, including transient hypotony in 2 eyes, elevated intraocular pressure in 2 eyes, and 1 case of retinal detachment managed with repeat PPV. The authors conclude that aggressive, prompt surgical management incorporating early PPV and source control can mitigate the historically poor prognosis associated with late bleb- and tube-related infections. While limited by a small sample size and single-centre retrospective design, this study provides valuable clinical evidence supporting early vitrectomy to preserve globe integrity and maximise functional vision in a challenging patient cohort.
Visual and anatomic outcomes in delayed-onset endophthalmitis after glaucoma surgery
Reviewed by Anitha Priya Arun Shankar
Visual and anatomic outcomes in delayed-onset endophthalmitis after glaucoma surgery: A 10-year case series.
