Bleb-Related Endophthalmitis Case Study

Treatment
Topical fluoroquinolones alone or in combination with one or two other antibiotics (aminoglycoside, cephalosporin) usually suffices for Blebitis type 1 & 2. The patient should be examined daily for the initial 1-2 weeks as there is always a possibility of rupture of the cystic bleb. Topical antibiotics should be continued for a period of 2-3 months and then tapered.

Early bleb related endophthalmitis is caused by Streptococcus epidermidis, Staphylococcus aureus, Propionibacterium acnes and other gram positive organisms. Late onset endophthalmitis is caused by Streptococcus, gram negative organisms such as Haemophilusinfluenzae, Moraxella, Pseudomonas and Serratia The treatment of bleb related endophthalmitis should be more aggressive than on the lines of edophthalmitis per se as the prognosis is poor. Prompt diagnosis and aggressive treatment is required to preserve the function of the eye and also to maintain the normal intraocular pressure in these glaucomatous eyes.
Treatment is initiated with intravitreal antibiotic (amikacin 0.4mg in 0.1ml, or ceftrioxone 2mg in 0.1ml, and vancomycin1.0 mg in 0.1 ml) along with topical antibiotics. Direct and immediate pars plana vitrectomy is beneficial and recommended if visual acuity on presentation is light perception or worse. If fungal infection is suspected or culture is positive for fungus, intravitreal amphotericin B, 5 µgm in 0.1 ml is given