Bleb-related endophthalmitis: Difference between revisions
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==Classification== | ==Classification== | ||
Depending on the timing of presentation and duration, bleb-related endophthalmitis (BAE) can be classified into either early onset (<6wks) or late onset(>6wks). | |||
==Pathophysiology== | ==Pathophysiology== | ||
==Causes== | ==Causes== | ||
*Early onset BAE | |||
**''[[Staphylococcus epidermidis]]'' | |||
*Late onset BAE | |||
**''[[Streptoccous species]]'' (31%) | |||
**Staphylococcus species (7%-22%) | |||
**[[Gram-negatives]] such as (''[[Haemophilus influenzae]]'' 23%, [[Enterococcus]] 7%, [[Pseudomonas]] 7%) | |||
==Differentiating Bleb-related Endophthalmitis from Other Diseases== | ==Differentiating Bleb-related Endophthalmitis from Other Diseases== | ||
| Line 21: | Line 27: | ||
==Risk Factors== | ==Risk Factors== | ||
* | *Late onset bleb leakage (increase the risk of bleb infection 26 fold) | ||
**Inappropriate use of of | **Inappropriate use of of The antifibrotic agents (such as [[5-fluorouracil|5-fluorouracil (5-FU)]] and Mitomycn-C (MMC)) | ||
***Reduce mucin production (secondry to loss of [[gablet cell]]) | |||
***Reduce mucin production | |||
***General conjunctival thinning | ***General conjunctival thinning | ||
***Reduced cellularity | ***Reduced cellularity | ||
***Avascular bleb | ***Avascular bleb | ||
***Epithelial irregularities, basement membrane breaks, and hypocellularity | |||
*Inferior and nasal placement of bleb | |||
*Conjunctivitis, | *Conjunctivitis, | ||
*Upper respiratory infection, | *Upper respiratory infection, | ||
| Line 49: | Line 56: | ||
===History and Symptoms=== | ===History and Symptoms=== | ||
====Symptoms=== | |||
*Ocular pain and discomfort | |||
*Redness | |||
*Blurred vision | |||
Eyebrow ache | |||
Headache, | |||
External ocular inflammation | |||
===Physical Examination=== | ===Physical Examination=== | ||
====Eye examination==== | |||
*Whitened bleb surrounded by intense [[conjunctival injection]] | |||
*A mucopurulent infiltrate, | |||
*Precipitates similar to keratic precipitates | |||
*[[Hypopyon]] within the bleb (often avascular with thin walls) | |||
*Anterior chamber reaction and/or a hypopyon, depending on the duration of the blebitis. Frequently, there is a | |||
*Bleb leak and consequent hypotony | |||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
| Line 74: | Line 95: | ||
===Prevention=== | ===Prevention=== | ||
====Primary Prevention==== | ====Primary Prevention==== | ||
*Assessment of bleb leakage following tabeculectomy surgery | *Assessment of bleb leakage following tabeculectomy surgery in every vist | ||
*Aggressive treatment of [[blebitis]] | |||
*Bleb revision with conjunctival advancement to manage avascular leaking blebs (100% success rate) | *Bleb revision with conjunctival advancement to manage avascular leaking blebs (100% success rate) | ||
*Amiotic membrane grafting as a possible alternative to conjunctival advancement (45% success rate) | *Amiotic membrane grafting as a possible alternative to conjunctival advancement (45% success rate) | ||
Revision as of 20:24, 25 July 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]
Overview
Bleb-related endophthalmitis (BRE) is the second most frequent cause of postoperative endophthalmitis after acute and chronic post-cataract surgery endophthalmitis.
Historical Perspective
Classification
Depending on the timing of presentation and duration, bleb-related endophthalmitis (BAE) can be classified into either early onset (<6wks) or late onset(>6wks).
Pathophysiology
Causes
- Early onset BAE
- Late onset BAE
- Streptoccous species (31%)
- Staphylococcus species (7%-22%)
- Gram-negatives such as (Haemophilus influenzae 23%, Enterococcus 7%, Pseudomonas 7%)
Epidemiology and Demographics
The incidence of bleb-related endophthalmitis is approximately range from 200 to 1300 per 100,000 individuals with . It's incidence is reported to be between 0.2% to 1.3%,2,3 and is more common with the use of antiproliferative agent (up to 3%) and even higher when the bleb is placed inferiorly (up to 9.4%).
Risk Factors
- Late onset bleb leakage (increase the risk of bleb infection 26 fold)
- Inappropriate use of of The antifibrotic agents (such as 5-fluorouracil (5-FU) and Mitomycn-C (MMC))
- Reduce mucin production (secondry to loss of gablet cell)
- General conjunctival thinning
- Reduced cellularity
- Avascular bleb
- Epithelial irregularities, basement membrane breaks, and hypocellularity
- Inappropriate use of of The antifibrotic agents (such as 5-fluorouracil (5-FU) and Mitomycn-C (MMC))
- Inferior and nasal placement of bleb
- Conjunctivitis,
- Upper respiratory infection,
- Blepharitis
- Diabetes
- Trabeculectomy alone compared to combined procedure
- Chronic antibiotic use
Screening
Natural History, Complications, and Prognosis
Natural History
Complications
Prognosis
A single-center retrospective review from the 1990s showed that the 5 year risk of blebitis and that of BAE is 6.3% and 7.5%, respectively.
Diagnosis
Diagnostic Criteria
History and Symptoms
=Symptoms
- Ocular pain and discomfort
- Redness
- Blurred vision
Eyebrow ache Headache, External ocular inflammation
Physical Examination
Eye examination
- Whitened bleb surrounded by intense conjunctival injection
- A mucopurulent infiltrate,
- Precipitates similar to keratic precipitates
- Hypopyon within the bleb (often avascular with thin walls)
- Anterior chamber reaction and/or a hypopyon, depending on the duration of the blebitis. Frequently, there is a
- Bleb leak and consequent hypotony
Laboratory Findings
Imaging Findings
X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Prevention
Primary Prevention
- Assessment of bleb leakage following tabeculectomy surgery in every vist
- Aggressive treatment of blebitis
- Bleb revision with conjunctival advancement to manage avascular leaking blebs (100% success rate)
- Amiotic membrane grafting as a possible alternative to conjunctival advancement (45% success rate)
Secondary prevention
- Bleb revision with conjunctival advancement to manage avascular leaking blebs (100% success rate)
- Amiotic membrane grafting as a possible alternative to conjunctival advancement (45% success rate)