Journal
OPHTHALMOLOGY RETINA
Volume 5, Issue 3, Pages 279-284Publisher
ELSEVIER INC
DOI: 10.1016/j.oret.2020.07.013
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Funding
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland [UL1TR002369]
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This study retrospectively analyzed the rate and outcomes of filtering-associated endophthalmitis in eyes that underwent trabeculectomy or tube-shunt implantation at our institution. Results showed a 5-year cumulative incidence of 1.32% for filtering-associated endophthalmitis, with relatively poor visual recovery but a high rate of globe salvage.
Purpose: To determine the rate, clinical features, and outcomes of filtering-associated endophthalmitis in eyes that underwent trabeculectomy or tube-shunt implantation. Design: Retrospective database study with selective chart review. Participants: Eyes that underwent incisional glaucoma surgery at our institution between January 1, 2012, and December 31, 2019. Methods: An electronic medical record database was used to identify all eyes that underwent trabeculectomy or tube-shunt implantation during the study period. Date of surgery, date of last ophthalmology clinic visit, and filtering-associated endophthalmitis diagnoses were obtained and used to perform a Kaplan-Meier analysis. The log-rank test was used to compare rates of filtering-associated endophthalmitis after trabeculectomy and tube-shunt implantation. Microbiology, management, and clinical outcomes data from patients with filtering-associated endophthalmitis were also collected and analyzed. Main Outcome Measures: Cumulative risk of filtering-associated endophthalmitis as determined by Kaplan-Meier analysis. Visual acuity improvement to within 2 lines of baseline at 3 months of follow-up and globe salvage at last available follow-up in eyes with filtering-associated endophthalmitis. Results: Kaplan-Meier analysis of 1582 eyes that underwent incisional glaucoma surgery yielded a 5-year cumulative incidence for filtering-associated endophthalmitis of 1.32%. No statistically significant differences were found between rate of endophthalmitis after trabeculectomy or tube-shunt implantation (P = 0.761, log-rank test). Seven of 16 cases (43.8%) of filtering-associated endophthalmitis showed positive culture results from either a vitreous sample or explanted tube shunt. Recovery of vision to within 2 lines of pre-endophthalmitis baseline was achieved in 53% of patients at 3 months of follow-up. Rate of globe salvage was 100% at last available follow-up. Conclusions: Risk of filtering-associated endophthalmitis is persistent and relatively constant for at least 5 years after incisional glaucoma surgery. The overall prognosis of filtering-associated endophthalmitis remains poor; however, good visual and anatomic outcomes can be achieved in some patients with prompt intervention. (C) 2020 by the American Academy of Ophthalmology
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