Background: Bleb-related endophthalmitis (BRE) is a disease associated with poor visual prognosis that may occur after a long period of time following trabeculectomy for glaucoma. We report a case of multiple BRE caused by different bacteria.
Case report: A 63-years-old man was referred to our hospital because of sudden ocular pain and decreased vision in the right eye and was suspected as having BRE. He reported a history of undergoing trabeculectomy at another hospital 8 years ago. At the initial visit to our hospital, best corrected visual acuity of his right eye was 0.03. An extensive avascular bleb, ciliary hyperemia, and hypopyon were observed on the auricular side of the right conjunctiva. The eye had an intraocular lens (IOL) inserted, and it was difficult to observe the fundus due to vitreous opacity. Following the diagnosis of StageIIIb BRE, vitrectomy was performed and the patient received medical treatment with antibiotics; the patient's visual acuity of his light eye improved to 1.2 after 2 months. Acinetobacter species. were detected in the vitreous humor on pathological investigation. However, 5 months after the initial surgery, he developed BRE with a severity higher than that of the initial infection. At the time of recurrence, visual acuity of light eye was 30 cm hand motion (n. c.). The fundus was not visible due to severe hypopyon. The patient underwent vitrectomy and IOL removal and was administered medication. Unlike that observed following the initial surgery, this time, Streptococcus species. were detected in the vitreous humor. Postoperatively, the symptoms of infection gradually subsided, but low intraocular pressure (IOP) persisted, and choroidal detachment and exudative retinal detachment occurred. Because the effect of air injection and other treatments was transient, silicone oil filling was performed. After removal of the silicone oil, the retina was attached and no recurrence of infection was observed; visual acuity of 0.03 and IOP of 15 mmHg were maintained.
Conclusion: BRE can occur repeatedly after trabeculectomy and may be associated with different causative bacteria.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 126: 457-462,2022.