From the Research
Immediate vitrectomy is generally recommended for bleb-associated endophthalmitis, regardless of presenting visual acuity, due to its virulent nature and potential for rapid progression with poor visual outcomes if not treated aggressively. The Endophthalmitis Vitrectomy Study (EVS) did not specifically address bleb-associated endophthalmitis, as it focused on acute postoperative endophthalmitis following cataract surgery. For bleb-associated endophthalmitis, patients should undergo prompt vitreous tap for culture followed by immediate vitrectomy, along with intravitreal antibiotics (typically vancomycin 1 mg/0.1 mL and ceftazidime 2.25 mg/0.1 mL) 1. Systemic antibiotics are also recommended, often including fluoroquinolones.
Key Considerations
- The severity and rapid progression of bleb-associated endophthalmitis generally necessitate immediate and aggressive surgical intervention regardless of initial visual acuity.
- The infection can progress rapidly with poor visual outcomes if not treated aggressively.
- The timing of intervention is critical, with better outcomes associated with treatment within 24 hours of symptom onset.
- Bleb-associated endophthalmitis is typically more virulent than post-cataract endophthalmitis, often involving more aggressive organisms like Streptococcus species and gram-negative bacteria.
Treatment Approach
- Prompt vitreous tap for culture
- Immediate vitrectomy
- Intravitreal antibiotics (vancomycin and ceftazidime)
- Systemic antibiotics (including fluoroquinolones)
Outcomes
- Visual outcomes are generally poor despite successful treatment of the infection 2.
- Intraocular pressure control may be challenging in some cases.
- The risk of enucleation or evisceration due to pain and/or poor vision is significant.
The most recent and highest quality study 1 supports the recommendation for immediate vitrectomy in cases of bleb-associated endophthalmitis, highlighting the importance of prompt and aggressive treatment to improve visual outcomes and prevent complications.