Implantable Glaucoma Devices Carry Risk of Endophthalmitis

Team of medical workers performing eye surgery
Instances of infection are rare but surgeons must be aware of the link, the study says.

Endophthalmitis instances are low following minimally invasive glaucoma surgery (MIGS), according to findings of a 5-year retrospective case series published in Ophthalmology. However, when they do occur, they are associated with implantable devices, the report identifies.

Patient records from the Wills Eye Hospital and Mid Atlantic Retina were retrospectively assessed for bacterial endophthalmitis diagnoses, MIGS procedures, and cataract procedures between 2015 and 2020.

Among all patients diagnosed with endophthalmitis (n=979), only 13 (1.3%) had undergone MIGS. Patients diagnosed with endophthalmitis following a MIGS procedure were aged between 62 and 91 years, 6 were women, 11 had concomitant cataract surgery, and the time to endophthalmitis diagnosis ranged between 2 days and 1.59 years.

A minority of these MIGS procedures (n=4) were performed at the research center.

Clinicians at Wills Eye Hospital and Mid Atlantic Retina performed 3055 MIGS procedures over the study period, indicating endophthalmitis was diagnosed among 0.13% (95% CI, 0.04%-0.30%) of in-house procedures.

The investigators observed that endophthalmitis was most commonly observed among patients who received 1 of 3 different implantable MIGS devicesNone of the MIGS procedures that did not employ an implantable device (n=437) were associated with endophthalmitis.

The detected causative organisms included various Streptococcus species (n=4), Staphylococcus epidermidis (n=2), and Staphylococcus aureus (n=1).

The researchers noted these observations contradicted previous findings which associated endophthalmitis following cataract surgery with coagulase negative staphylococcal species. The rate of endophthalmitis following the 15,148 cataract surgeries performed during the study period was 0.30% (95% CI, 0.22%-0.40%), suggesting endophthalmitis occurred at a similar rate after MIGS but were caused by more virulent organisms.

This study was limited by only having access to diagnoses made at their center, which likely indicated endophthalmitis was underreported.

These findings suggested that rates of endophthalmitis were rare following MIGS and associated with implantable devices. Risk for endophthalmitis appears to vary on the basis of implant type, indicating that each device likely requires unique management.

Disclosure: Some study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  


Starr MR, Huang D, Israilevich R, et al. Endophthalmitis following minimally invasive glaucoma surgery. Ophthalmol. 2021;S0161-6420(21)00414-0. doi:10.1016/j.ophtha.2021.06.004