Infected Baerveldt Glaucoma Drainage Device by Aspergillus niger

Management of endophthalmitis related to glaucoma drainage devices: review of the literature and our experience

Glaucoma drainage device (GDD)-related endophthalmitis is a devastating complication of device implantation. There are no guidelines in the literature to assist clinicians in deciding if the GDD should be explanted or if patients require pars plana vitrectomy (PPV). This study compares the outcomes of GDD explantation with device retention and also independently compares the outcomes of PPV versus intravitreal antibiotics alone in patients with GDD-related endophthalmitis. A literature search for studies discussing GDD-related endophthalmitis from 2005 to 2019 was performed; 30 articles were included. The visual acuity/anatomical outcomes were compared between GDD explantation and retention, and between patients that received a PPV and those that did not. These outcomes were combined with a medical records review of 13 patients with GDD-related endophthalmitis from an academic institution. A total of 88 eyes were included. 70.5% underwent GDD explantation, while 37.8% received a PPV. GDD explantation was associated with a lower rate of evisceration/enucleation when compared to GDD retention (4.8% versus 19.2%, OR 0.22, 95% CI 0.05-1.01, p = 0.05), but visual acuity outcomes were similar. No eyes that received an immediate vitrectomy became phthisic or required evisceration/enucleation, compared an evisceration/enucleation rate of 15.2% in eyes treated solely with intravitreal antibiotics (OR 1.18, 95% CI 1.04-1.33, p = 0.04). Explantation of the GDD and immediate vitrectomy are both associated with better anatomical outcomes in GDD-related endophthalmitis. Further research is needed to provide more definitive guidelines in the ideal management of these patients.

Deep Keratomycosis Following Ahmed Glaucoma Valve Implantation

Purpose:

To report an unusual case of deep keratomycosis after Ahmed glaucoma valve (AGV) implantation.

Methods:

A 70-year-old male presented with a deep corneal stromal infiltrate, without epithelial involvement, 3 weeks after a successful AGV implantation for neovascular glaucoma. Microscopic examination of the anterior chamber exudates revealed fungal filaments on smear, and white fungal colonies were observed on the Blood agar and Sabouraud dextrose agar. The fungus was identified as Aspergillus flavus.

Results:

The patient was treated with oral and topical 1% voriconazole. Ten weeks after the treatment, the corneal infiltrate resolved, resulting in a vascularized scar.

Conclusion:

As recalcitrant keratomycosis of the deep corneal layers may occur after AGV implantation, early identification and prompt treatment may help to achieve complete resolution of the infection and salvage the eye.

Polymicrobial infection confined to Ahmed glaucoma shunt

Purpose

To present a case of a unique complication of an Ahmed glaucoma shunt. The pathological and immunohistochemical findings will also be discussed.

Observations

A 58-year-old woman with glaucoma secondary to Marfan syndrome and cataract surgery developed exposure of an Ahmed glaucoma tube, intraluminal white inflammatory material, and low-grade endophthalmitis five years after insertion. The patient was treated with topical and oral antibiotics and successfully underwent removal and replacement of the shunt. Pathologic analysis of the intraluminal contents revealed a bacterial infiltrate of mixed morphology.

Conclusions and Importance

Concurrent tube exposure, intraluminal exudates, and endophthalmitis is a rare but potentially serious complication of glaucoma drainage device surgery. When this complication is encountered, prompt medical and surgical intervention is necessary to prevent significant vision loss. Ultimately, the glaucoma shunt may be revised, replaced, or removed altogether from the eye.

Diagnostic and Management Strategies of Aspergillus Endophthalmitis: Current Insights

Fungal endophthalmitis is subsequent to endogenous or exogenous infection and represents an important complication of ocular surgery which may lead to significant visual loss and blindness. The prognosis is poor because of delayed diagnosis and limited availability of effective antifungal drugs with good ocular penetration. Furthermore, the critical issue in diagnosing fungal infection of the eye is microbiological identification of the etiologic agent in clinical samples. Aspergillus is among the most frequent isolated organisms in fungal endophthalmitis. Early diagnosis is essential to prevent severe complications and blindness. Treatments include local, systemic and surgical therapeutic strategies. The purpose of the present review is the analysis of the current procedures adopted to promptly diagnose and treat Aspergillus endophthalmitis.