To describe predisposing factors, presentation, management, and outcome of glaucoma drainage implant (GDI)-associated endophthalmitis DESIGN: Retrospective chart review SUBJECTS: Eyes that developed GDI-associated endophthalmitis between December 1, 2011 to December 23, 2019 at the Duke Eye Center and Cole Eye Institute.
Patient data search was performed based on diagnostic codes for GDI and endophthalmitis. Endophthalmitis was defined clinically according to each physician’s discretion. Eyes with infection source other than GDI was excluded. Worse vision was defined as a drop of more than 2 Snellen lines. Data was collected on baseline demographics, systemic and ocular comorbidities, ocular surgical history, best corrected visual acuity (BCVA), intraocular pressures (IOP), clinical presentation, eye culture results, and treatments performed. Statistical analysis included the paired T-test and odds radio calculations.
Visual acuity and intraocular pressure at final follow up RESULTS: Thirty (0.7%) cases of GDI-endophthalmitis were identified among 4073 glaucoma drainage implants performed at the two institutions with active follow-up. Device exposure was identified in 20 (67%) eyes on presentation. The average follow-up after presentation was 22.4 ± 25 months. The most frequently identified organism on culture was Streptococcus pneumoniae. Same-day injection of intravitreal antibiotics was the universal first line therapy. From baseline to final follow up, the mean BCVA decreased from -0.84 ± 0.77 to -1.30 ± 0.93 (LogMar, P = 0.02). Mean IOP did not change from baseline to final visit in the overall cohort (16.2 ± 8.2 mmHg to 14.6 ± 9.4 mmHg, P = 0.30) and in the subgroup that underwent tube explant (15.9 ± 5.5 mmHg to 15.2 ± 10.4 mmHg, P = 0.97). Eighteen of 20 tube exposure cases (90%) underwent tube explant, one underwent tube revision, and one re-epithelialized.
GDI-associated endophthalmitis was correlated with poor visual outcome. Immediate intravitreal antibiotic delivery was a universal first line therapy. Tube exposure was a necessary risk factor for late onset endophthalmitis and required surgical removal or repair.
Copyright © 2020. Published by Elsevier Inc.