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Bleb Associated
Common organisms-
-Propionibacterium acnes
-S.epidermidis
-fungi
Persistent /recurrent uveitis following surgery
Bleb Associated infectious
Endophthalmitis
Following glaucoma filtering surgery
Blebitis purulent endophthalmitis
Common organisms
-Streptococcus spp
-Haemophilus influenza
Risk Factors :
- Local antimetabolite therapy [thin walled drainage bleb]
- Blepharitis
- Nasally or inferior placed & leaky bleb.
Blebitis:
Symptoms :-
Mild discomfort & redness
Signs:-
- White bleb
- No anterior uveitis
- Normal Red reflex
Treatment :-
- Topical ofloxacin & Vancomycin
- Tab Co-amoxiclav 500/125 mg tid
- Tab Ciprofloxacin 750 mg bd - 5 days
Endophthalmitis:
Symptoms :-
- Rapidly worsening vision, pain,redness ,stickiness
Signs :-
-White milky bleb with pus
- Severe anterior uveitis with hypopyon
-Vitritis , poor red reflex..
Ocular manifestations:
Symptoms:
-Blurred vision
-Red eye
-Pain
-Photophobia
Signs :
-Decreased visual acuity
-Eyelid edema
-Erytema
-Conjunctival hyperemia
-Chemosis
-Corneal edema & Opacification
- AC flare and cells ,Keratic preciptates [low grade in delayed]
- Hypopyon [not in delayed]
- Vitritis
-Scattered retinal haemorrhages
-Periphlebitis if retina visible
-Loss of red refex
- Capsular plaque[ in delayed]
Diagnosis
Early recognition & suspicion is critical
IntraVitreal
Vancomycin 1.0 mg in 0.1 ml
Amikacin 0.2-0.4 mg in 0.1 ml or
Ceftazidime 2.25 mg in 0.1 ml
Dexamethsone 400 ug in 0.1 ml [optional]
Oral
Prednisolone 30 mg twice daily for 10 days if no
contraindications
Moxifloxacin 400 mg daily
Clarithromycin 500 mg twice daily
Topical :
-Vancomycin 5 %
- Ceftazidime 5%
- Dexamethasone 0.1 %
Endophthalmitis Vitrectomy Study
[EVS]
From Arch Ophthalmol. 1995 Dec;113(12):1479-96.
Hand motion or
better Light perception
48 hrs 48 hrs
Positive culture