Bleb-related endophthalmitis: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
Line 9: Line 9:


==Classification==
==Classification==
Depending on the timing of presentation and duration, bleb-related endophthalmitis (BAE) can be classified into either early onset (<6wks) or late onset(>6wks). 


==Pathophysiology==
==Pathophysiology==


==Causes==
==Causes==
 
*Early onset BAE
**''[[Staphylococcus epidermidis]]'' 
*Late onset BAE
**''[[Streptoccous species]]'' (31%)
**Staphylococcus species (7%-22%)
**[[Gram-negatives]] such as (''[[Haemophilus influenzae]]'' 23%, [[Enterococcus]] 7%, [[Pseudomonas]] 7%)
==Differentiating Bleb-related Endophthalmitis from Other Diseases==
==Differentiating Bleb-related Endophthalmitis from Other Diseases==


Line 21: Line 27:


==Risk Factors==
==Risk Factors==
*Bleb leakage (increase the risk of bleb infection 26 fold)
*Late onset bleb leakage (increase the risk of bleb infection 26 fold)
**Inappropriate use of  of anti-metabolites (such as [[5-fluorouracil|5-fluorouracil (5-FU)]])
**Inappropriate use of  of The antifibrotic agents (such as [[5-fluorouracil|5-fluorouracil (5-FU)]] and  Mitomycn-C (MMC))
**Inappropriate use of Mitomycn-C (MMC)
***Reduce mucin production (secondry to loss of [[gablet cell]])
***Reduce mucin production
***General conjunctival thinning
***General conjunctival thinning
***Reduced cellularity
***Reduced cellularity
***Avascular bleb
***Avascular bleb
***Epithelial irregularities, basement membrane breaks, and hypocellularity
*Inferior and nasal placement of bleb
*Conjunctivitis,
*Conjunctivitis,
*Upper respiratory infection,
*Upper respiratory infection,
Line 49: Line 56:


===History and Symptoms===
===History and Symptoms===
====Symptoms===
*Ocular pain and  discomfort
*Redness
*Blurred vision
Eyebrow ache
Headache,
External ocular inflammation


===Physical Examination===
===Physical Examination===
====Eye examination====
*Whitened bleb surrounded by intense [[conjunctival injection]]
*A mucopurulent infiltrate,
*Precipitates similar to keratic precipitates
*[[Hypopyon]] within the bleb (often avascular with thin walls)
*Anterior chamber reaction and/or a hypopyon, depending on the duration of the blebitis. Frequently, there is a
*Bleb leak and consequent hypotony


===Laboratory Findings===
===Laboratory Findings===
Line 74: Line 95:
===Prevention===
===Prevention===
====Primary Prevention====
====Primary Prevention====
*Assessment of bleb leakage following tabeculectomy surgery
*Assessment of bleb leakage following tabeculectomy surgery in every vist
*Aggressive treatment of [[blebitis]]
*Bleb revision with conjunctival advancement to manage avascular leaking blebs (100% success rate)
*Bleb revision with conjunctival advancement to manage avascular leaking blebs (100% success rate)
*Amiotic membrane grafting as a possible alternative to conjunctival advancement (45% success rate)
*Amiotic membrane grafting as a possible alternative to conjunctival advancement (45% success rate)

Revision as of 20:24, 25 July 2016

WikiDoc Resources for Bleb-related endophthalmitis

Articles

Most recent articles on Bleb-related endophthalmitis

Most cited articles on Bleb-related endophthalmitis

Review articles on Bleb-related endophthalmitis

Articles on Bleb-related endophthalmitis in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Bleb-related endophthalmitis

Images of Bleb-related endophthalmitis

Photos of Bleb-related endophthalmitis

Podcasts & MP3s on Bleb-related endophthalmitis

Videos on Bleb-related endophthalmitis

Evidence Based Medicine

Cochrane Collaboration on Bleb-related endophthalmitis

Bandolier on Bleb-related endophthalmitis

TRIP on Bleb-related endophthalmitis

Clinical Trials

Ongoing Trials on Bleb-related endophthalmitis at Clinical Trials.gov

Trial results on Bleb-related endophthalmitis

Clinical Trials on Bleb-related endophthalmitis at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Bleb-related endophthalmitis

NICE Guidance on Bleb-related endophthalmitis

NHS PRODIGY Guidance

FDA on Bleb-related endophthalmitis

CDC on Bleb-related endophthalmitis

Books

Books on Bleb-related endophthalmitis

News

Bleb-related endophthalmitis in the news

Be alerted to news on Bleb-related endophthalmitis

News trends on Bleb-related endophthalmitis

Commentary

Blogs on Bleb-related endophthalmitis

Definitions

Definitions of Bleb-related endophthalmitis

Patient Resources / Community

Patient resources on Bleb-related endophthalmitis

Discussion groups on Bleb-related endophthalmitis

Patient Handouts on Bleb-related endophthalmitis

Directions to Hospitals Treating Bleb-related endophthalmitis

Risk calculators and risk factors for Bleb-related endophthalmitis

Healthcare Provider Resources

Symptoms of Bleb-related endophthalmitis

Causes & Risk Factors for Bleb-related endophthalmitis

Diagnostic studies for Bleb-related endophthalmitis

Treatment of Bleb-related endophthalmitis

Continuing Medical Education (CME)

CME Programs on Bleb-related endophthalmitis

International

Bleb-related endophthalmitis en Espanol

Bleb-related endophthalmitis en Francais

Business

Bleb-related endophthalmitis in the Marketplace

Patents on Bleb-related endophthalmitis

Experimental / Informatics

List of terms related to Bleb-related endophthalmitis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

Overview

Bleb-related endophthalmitis (BRE) is the second most frequent cause of postoperative endophthalmitis after acute and chronic post-cataract surgery endophthalmitis.

Historical Perspective

Classification

Depending on the timing of presentation and duration, bleb-related endophthalmitis (BAE) can be classified into either early onset (<6wks) or late onset(>6wks).

Pathophysiology

Causes

Differentiating Bleb-related Endophthalmitis from Other Diseases

Epidemiology and Demographics

The incidence of bleb-related endophthalmitis is approximately range from 200 to 1300 per 100,000 individuals with . It's incidence is reported to be between 0.2% to 1.3%,2,3 and is more common with the use of antiproliferative agent (up to 3%) and even higher when the bleb is placed inferiorly (up to 9.4%).

Risk Factors

  • Late onset bleb leakage (increase the risk of bleb infection 26 fold)
    • Inappropriate use of of The antifibrotic agents (such as 5-fluorouracil (5-FU) and Mitomycn-C (MMC))
      • Reduce mucin production (secondry to loss of gablet cell)
      • General conjunctival thinning
      • Reduced cellularity
      • Avascular bleb
      • Epithelial irregularities, basement membrane breaks, and hypocellularity
  • Inferior and nasal placement of bleb
  • Conjunctivitis,
  • Upper respiratory infection,
  • Blepharitis
  • Diabetes
  • Trabeculectomy alone compared to combined procedure
  • Chronic antibiotic use

Screening

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

A single-center retrospective review from the 1990s showed that the 5 year risk of blebitis and that of BAE is 6.3% and 7.5%, respectively.

Diagnosis

Diagnostic Criteria

History and Symptoms

=Symptoms

  • Ocular pain and discomfort
  • Redness
  • Blurred vision

Eyebrow ache Headache, External ocular inflammation

Physical Examination

Eye examination

  • Whitened bleb surrounded by intense conjunctival injection
  • A mucopurulent infiltrate,
  • Precipitates similar to keratic precipitates
  • Hypopyon within the bleb (often avascular with thin walls)
  • Anterior chamber reaction and/or a hypopyon, depending on the duration of the blebitis. Frequently, there is a
  • Bleb leak and consequent hypotony

Laboratory Findings

Imaging Findings

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

Primary Prevention

  • Assessment of bleb leakage following tabeculectomy surgery in every vist
  • Aggressive treatment of blebitis
  • Bleb revision with conjunctival advancement to manage avascular leaking blebs (100% success rate)
  • Amiotic membrane grafting as a possible alternative to conjunctival advancement (45% success rate)

Secondary prevention

  • Bleb revision with conjunctival advancement to manage avascular leaking blebs (100% success rate)
  • Amiotic membrane grafting as a possible alternative to conjunctival advancement (45% success rate)

References


Template:WS Template:WH