Bleb-Associated Endophthalmitis

An adult patient presented to the Bascom Palmer emergency room for evaluation of two days of pain, redness, discharge, and vision loss of the left eye. He had a history of open angle glaucoma and underwent trabeculectomy bilaterally in both eyes two years prior to presentation. His vision on presentation was 20/25 in the right eye and hand motion in the left. On slit lamp examination he was found to have a purulent bleb with significant anterior chamber inflammation and hypopyon. There was no posterior view on exam of the left eye. B-scan revealed moderate vitreous opacities in the left eye greater than the right eye. Due to concern for bleb-associated endophthalmitis, the patient underwent intravitreal injection with vancomycin and ceftazidime along with an anterior chamber paracentesis for culture. The next day his examination did not improve and he was found to have dense membranes in the vitreous in repeat B-scan. The patient underwent pars plana vitrectomy with intravitreal and subconjunctival injections vancomycin and ceftazidime. Two weeks after surgery his vision improved to 20/800 in the left eye with significant improvement in intraocular inflammation. Anterior chamber and vitreous cultures remained with no growth, however the samples demonstrated gram-positive cocci bacteria on gram stain.

Presentation Date: 08/17/2023

Issue Date: 08/25/2023