Vol 33 No. 2 Case Report PDF

Bleb-related endophthalmitis

Angelito Braulio F. de Venecia III, MD, Ruben Lim Bon Siong, MD, Margarita Lat-Luna, MD

To report the risk factors, diagnosis, and treatment of bleb-related infections.

This is a case report.

Two patients presented with acute pain, redness, and blurring of vision in the left eye. Both had undergone trabeculectomy with mitomycin C (MMC) for advanced chronic angle-closure glaucoma several years ago and were lost to follow-up. On consultation, both had severe conjunctival congestion, with severe anterior-chamber (AC) reaction, and hypopyon. The cystic blebs were thinned out with visible infiltrates. Ocular ultrasound revealed vitreous cells. Culture and sensitivity tests confirmed the presence of blebitis with secondary endophthalmitis. Both patients were treated with intravenous moxifloxacin, atropine sulfate and moxifloxacin eye drops. Upon control of infection, they were started on topical steroid. Both responded well to treatment.

Bleb-related infection is one of the complications of glaucoma filtration surgery that clinicians should consider when presented with complaints of acute pain, redness, and blurring of vision following trabeculectomy. Diagnosis should include staining, culture and sensitivity studies. Prompt treatment with broad-spectrum antibiotic is paramount to preserve vision.

Keywords: Bleb, Trabeculectomy, Endophthalmitis, Glaucoma, Mitomycin C