Hye Jin Kwon1,2, Himeesh Kumar1, Catherine Green1,3, Jonathan Crowston1,3, Penelope Allen1,3, Nathan Kerr3,4

Purpose: To examine the rates, presentation, management and outcomes of bleb-associated endophthalmitis between 1997 and 2015 in Victoria.

Methods: Retrospective consecutive chart review of patients with bleb-related endophthalmitis between 1997 and 2015 at the Royal Victorian Eye and Ear Hospital.

Results: Sixty-seven eyes were diagnosed with bleb-related endophthalmitis. There was a decreasing number of cases over the study period. The mean age was 73.7 ± 12.1 years old. The mean duration of symptoms were 3.6 ± 4.7 days and reduced vision was the most common reason for presentation. At presentation, the mean visual acuity was 2.9 ± 1.5 logMAR and intraocular pressure was 21.8 ± 14.2 mmHg. A bleb leak was present in 16 (23.9 %) cases and loose sutures were noted in 6 (9 %) cases. All patients underwent anterior chamber and/or vitreous taps followed by injection of intravitreal antibiotics. Forty-three (64.2 %) patients received systemic antibiotics. Sixteen (23.9 %) eyes required subsequent vitrectomy. Cultures were positive in 50 (74.6 %) cases and the most common organisms were Streptococcus (31.3%), Moraxella (14.9 %), Staphylococcus (10.4 %), and Haemophilus (7.5 %) species. The final visual acuity was 2.5 ± 1.8 logMAR at a mean follow up duration of 15.8 (0.1-160) months. Nine (10.5%) eyes developed retinal detachment and 8 (11.9 %) eyes required enucleation.

Conclusion: Bleb-related endophthalmitis is a rare trabeculectomy complication in Victoria but it carries a poor visual prognosis despite treatment. Patients should be educated about early symptoms and the need to seek immediate ophthalmic attention.