Endophthalmitis trends and outcomes following glaucoma surgery at a tertiary eye care hospital in Saudi Arabia

Purpose: To compare the incidence, microbial profile, management and outcomes of endophthalmitis after glaucoma drainage implant (GDI), or trabeculectomy over 2 separate time periods before and after the year 2000. Methods: A chart review was performed for patients with endophthalmitis after trabeculectomy (trabeculectomy group) or GDI group between 1983 to 1999 (group 1) and 2000 to 2011 (group 2) at a tertiary care hospital. Data were compared between groups and time periods. Results: There were 56 cases of endophthalmitis after trabeculectomy in group 1 and 17 cases in group 2. After GDI, there were 10 cases of endophthalmitis in group 1 and 1 case in group 2. The incidence of endophthalmitis after GDI decreased significantly from 0.0105% to 0.00074% in groups 1 and 2, respectively (P<0.05). The incidence of endophthalmitis decreased significantly after trabeculectomy from 0.007% in group 1 to 0.00197% in group 2 (P=0.0004). There were 26 culture-positive cases in group 1 and 10 in group 2. The most common isolates were Streptococcus species in group 1 and Staphylococcus species in group 2. Indicators of morbidity were lower in group 2. The final visual outcome in either group was not correlated to the type of surgery, microbes, or initial management. Conclusions: There was a greater incidence of endophthalmitis after trabeculectomy compared with GDI. The incidence of endophthalmitis decreased from 2001 to 2011 compared with 1983 to 1999, which is likely due to advances in surgical technique. However, significant visual morbidity does occur despite prompt treatment.