PPV, Vitreous Biopsy Yield Similar Visual Outcomes in Eyes With Bleb-Related Endophthalmitis

High-speed vitrector being used during eye operation, during a pars plana vitrectomy. Close-up, High-speed vitrector is introduced into the wound to carry out the remainder of the liquefaction. Sometimes instruments do not perform as well as a surgeon would like, so they can be replaced mid-surgery. (Photo by Universal Images Group via Getty Images)
Both procedures yield similar visual outcomes, isolated organisms, and IOP control in eyes with delayed-onset bleb-related endophthalmitis, a report shows.

Among eyes with delayed-onset bleb-related endophthalmitis (BRE), visual outcomes, isolated organisms and intraocular pressure (IOP) control are similar whether they undergo treatment with initial pars plana vitrectomy (PPV) or vitreous biopsy and injection of intravitreal antibiotics (TI), according to a study published in the Journal of Glaucoma

Researchers conducted a retrospective chart review at the Bascom Palmer Eye Institute and University of Florida to identify patients treated for BRE with at least 1 month of follow-up from the implementation of an electronic health record (2011 and 2014, respectively) through 2021. All patients underwent bleb-forming glaucoma surgery at least 1 month before endophthalmitis diagnosis. 

A total of 39 eyes from 39 patients (mean age: 72.5 years, age range: 37-92 years, 21 men, 18 women) were included in the study. Overall, 30 eyes (76.9%) underwent TI and 9 eyes (23.1%) underwent PPV. Eyes that underwent PPV had worse baseline visual acuity (VA), (logMAR 2.51 vs 2.16, P =.04), but VA at the last follow up was similar (P =.48) in both treatment groups.

The most common organisms were Streptococcus species (9 eyes, 23.1%) and Staphylococcus species (8 eyes, 20.5%), and were similar in both groups (P =.5). Following recovery from BRE, the average IOP in the PPV group was 15.1 mmHg on 0.9 IOP-lowering medications compared with 12.6 mmHg on 1.2 medications in the TI group (IOP: P =.56; medications: P =.80), according to the study. A total of 44.4% of the PPV eyes and 16.7% of the TI eyes underwent additional glaucoma surgery. 

Limitations of the study include its retrospective design, the relatively small sample of eyes that underwent initial PPV, and the possibility of selection bias due to patients not being randomly assigned to treatment.

“BRE is a serious complication of glaucoma filtration surgery,” according to the researchers. “The current study reports similar isolated organisms, visual outcomes and IOP control in eyes treated with pars plana vitrectomy compared to vitreous biopsy and intravitreal antibiotics.”

Disclosure: This research was supported by multiple sources. Please see the original reference for a full list of disclosures.  


Islam YFK, Vanner EA, Khurshid SG, Flynn HW Jr, Greenfield DS. Comparison of outcomes from delayed onset bleb-related endophthalmitis treated with pars plana vitrectomy versus vitreous biopsy. J Glaucoma. Published online June 2, 2022. doi:10.1097/IJG.0000000000002056