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David S. Greenfield, MD; Ivan J. Suñer, MD; Michael P. Miller, MD; Tracy A. Kangas, MD, PhD; Paul F. Palmberg, MD, PhD; Harry W. Flynn, Jr, MD

Arch Ophthalmol. 1996;114(8):943-949.

Abstract
Objective
To identify the incidence, causative organisms, and clinical outcomes of eyes with bleb-associated endophthalmitis after glaucoma filtering procedures with adjunctive mitomycin.

Methods
Retrospective analysis of 773 consecutive eyes that underwent glaucoma filtering surgery at the Bascom Palmer Eye Institute, Miami, Fla. The course of 609 eyes from 485 patients with a minimum of 3 months of follow-up were reviewed.

Results
Mean follow-up was 16.0±11.5 months (range, 3-48 months). Of the 609 eyes, 13(2.1%) developed bled-associated endophthalmitis an average of 18.5±13.2 months after surgery (range, 1-45 months). The incidence of bleb-associated endophthalmitis was significantly greater after inferior trabeculectomy (7.8% per patient-year) than after superior trabeculectomy (1.3% per patient-year) by Kaplan-Meier estimates (P=.02, log rank test). The cumulative incidence was 13% for inferior limbal blebs and 1.6% for superior limbal blebs. Nine (69.2%) of the 13 eyes were culture positive. Streptococcus sanguis and Haemophilus influenzae (6/13 [46.2%]) were the most frequent causative organisms. The mean increase in intraocular pressure after endophthalmitis treatment was 1.2 mm Hg, with a mean decrease in visual acuity of 1.42 log MAR units. Eight (61.5%) of the 13 eyes had a final acuity of 20/400 or better.

Conclusions
The incidence of bleb-associated endophthalmitis after guarded filtering surgery performed with adjunctive mitomycin is higher than the reported rate in eyes undergoing filtering surgery without the use of antifibrotic agents (0.2%-1.5%). Inferior limbal trabeculectomy carries the highest risk of infection. Eyes with mitomycin blebs maintained excellent filtration capacity. However, after treatment of the infection, the visual outcomes were generally poor.

Author Affiliations
From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami (Fla) School of Medicine. Dr Greenfield is now with The New York (NY) Eye and Ear Infirmary. The authors have no proprietary interest in any of the materials presented in this report.

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