A rare case of endophthalmitis after bleb needle revision for glaucoma Xen® gel stent

Luca Napoli, Ivano Riva, Francesco Oddone, Manuele Michelessi, Luciano Quaranta

Research output: Contribution to journalArticle

Abstract

Purpose: To describe the first case of endophthalmitis caused by Sphingobacterium spiritivorum, a glucose non-fermenting Gram-negative rod, in a patient previously implanted with a Xen® gel stent. Case report description: An 83-year-old patient, affected by open-angle glaucoma and with a previous surgery of combined cataract extraction and Xen gel stent implantation, developed endophthalmitis 1 month after bleb needle revision with 5-fluorouracil injection. At presentation, best corrected visual acuity was hand movement, hypopyon was evident into the anterior chamber and a flat bleb with no sign of leakage was present over the Xen gel implant. Outcome: Immediate pars plana vitrectomy was performed, with intravitreal antibiotic administration and silicon oil tamponade. S. spiritivorum was isolated from vitreous bacterial culture. According to the antibiogram, patient was treated with topical fortified ceftazidime eyedrops and appropriate systemic antibiotics (intravenous meropenem, 500 mg every 8 h for 7 days, followed by oral cotrimoxazole, 160 + 800 mg, twice a day for 10 days). After 2 weeks of treatment, ocular inflammation was resolved, best corrected visual acuity was 0.1 (Snellen chart) and intraocular pressure was 18 mm Hg without topical hypotensive therapy. Conclusion: S. spiritivorum was isolated for the first time as a causative agent of endophthalmitis in humans. Bleb needle revision in patients with Xen gel implant is not free of complications, and an attentive follow-up is required.

Original languageEnglish
JournalEuropean Journal of Ophthalmology
DOIs
Publication statusAccepted/In press - Jan 1 2019

Fingerprint

Endophthalmitis
Blister
Glaucoma
Needles
Stents
Gels
meropenem
Visual Acuity
Sphingobacterium
Anti-Bacterial Agents
Ceftazidime
Temazepam
Cataract Extraction
Ophthalmic Solutions
Open Angle Glaucoma
Vitrectomy
Sulfamethoxazole Drug Combination Trimethoprim
Microbial Sensitivity Tests
Anterior Chamber
Silicon

Keywords

  • endophthalmitis
  • Glaucoma
  • intraocular pressure
  • trabeculectomy
  • Xen gel

ASJC Scopus subject areas

  • Ophthalmology

Cite this

A rare case of endophthalmitis after bleb needle revision for glaucoma Xen® gel stent. / Napoli, Luca; Riva, Ivano; Oddone, Francesco; Michelessi, Manuele; Quaranta, Luciano.

In: European Journal of Ophthalmology, 01.01.2019.

Research output: Contribution to journalArticle

@article{96869c0542fa46f3b5e32b8ded90739d,
title = "A rare case of endophthalmitis after bleb needle revision for glaucoma Xen{\circledR} gel stent",
abstract = "Purpose: To describe the first case of endophthalmitis caused by Sphingobacterium spiritivorum, a glucose non-fermenting Gram-negative rod, in a patient previously implanted with a Xen{\circledR} gel stent. Case report description: An 83-year-old patient, affected by open-angle glaucoma and with a previous surgery of combined cataract extraction and Xen gel stent implantation, developed endophthalmitis 1 month after bleb needle revision with 5-fluorouracil injection. At presentation, best corrected visual acuity was hand movement, hypopyon was evident into the anterior chamber and a flat bleb with no sign of leakage was present over the Xen gel implant. Outcome: Immediate pars plana vitrectomy was performed, with intravitreal antibiotic administration and silicon oil tamponade. S. spiritivorum was isolated from vitreous bacterial culture. According to the antibiogram, patient was treated with topical fortified ceftazidime eyedrops and appropriate systemic antibiotics (intravenous meropenem, 500 mg every 8 h for 7 days, followed by oral cotrimoxazole, 160 + 800 mg, twice a day for 10 days). After 2 weeks of treatment, ocular inflammation was resolved, best corrected visual acuity was 0.1 (Snellen chart) and intraocular pressure was 18 mm Hg without topical hypotensive therapy. Conclusion: S. spiritivorum was isolated for the first time as a causative agent of endophthalmitis in humans. Bleb needle revision in patients with Xen gel implant is not free of complications, and an attentive follow-up is required.",
keywords = "endophthalmitis, Glaucoma, intraocular pressure, trabeculectomy, Xen gel",
author = "Luca Napoli and Ivano Riva and Francesco Oddone and Manuele Michelessi and Luciano Quaranta",
year = "2019",
month = "1",
day = "1",
doi = "10.1177/1120672119878016",
language = "English",
journal = "European Journal of Ophthalmology",
issn = "1120-6721",
publisher = "Wichtig Publishing",

}

TY - JOUR

T1 - A rare case of endophthalmitis after bleb needle revision for glaucoma Xen® gel stent

AU - Napoli, Luca

AU - Riva, Ivano

AU - Oddone, Francesco

AU - Michelessi, Manuele

AU - Quaranta, Luciano

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: To describe the first case of endophthalmitis caused by Sphingobacterium spiritivorum, a glucose non-fermenting Gram-negative rod, in a patient previously implanted with a Xen® gel stent. Case report description: An 83-year-old patient, affected by open-angle glaucoma and with a previous surgery of combined cataract extraction and Xen gel stent implantation, developed endophthalmitis 1 month after bleb needle revision with 5-fluorouracil injection. At presentation, best corrected visual acuity was hand movement, hypopyon was evident into the anterior chamber and a flat bleb with no sign of leakage was present over the Xen gel implant. Outcome: Immediate pars plana vitrectomy was performed, with intravitreal antibiotic administration and silicon oil tamponade. S. spiritivorum was isolated from vitreous bacterial culture. According to the antibiogram, patient was treated with topical fortified ceftazidime eyedrops and appropriate systemic antibiotics (intravenous meropenem, 500 mg every 8 h for 7 days, followed by oral cotrimoxazole, 160 + 800 mg, twice a day for 10 days). After 2 weeks of treatment, ocular inflammation was resolved, best corrected visual acuity was 0.1 (Snellen chart) and intraocular pressure was 18 mm Hg without topical hypotensive therapy. Conclusion: S. spiritivorum was isolated for the first time as a causative agent of endophthalmitis in humans. Bleb needle revision in patients with Xen gel implant is not free of complications, and an attentive follow-up is required.

AB - Purpose: To describe the first case of endophthalmitis caused by Sphingobacterium spiritivorum, a glucose non-fermenting Gram-negative rod, in a patient previously implanted with a Xen® gel stent. Case report description: An 83-year-old patient, affected by open-angle glaucoma and with a previous surgery of combined cataract extraction and Xen gel stent implantation, developed endophthalmitis 1 month after bleb needle revision with 5-fluorouracil injection. At presentation, best corrected visual acuity was hand movement, hypopyon was evident into the anterior chamber and a flat bleb with no sign of leakage was present over the Xen gel implant. Outcome: Immediate pars plana vitrectomy was performed, with intravitreal antibiotic administration and silicon oil tamponade. S. spiritivorum was isolated from vitreous bacterial culture. According to the antibiogram, patient was treated with topical fortified ceftazidime eyedrops and appropriate systemic antibiotics (intravenous meropenem, 500 mg every 8 h for 7 days, followed by oral cotrimoxazole, 160 + 800 mg, twice a day for 10 days). After 2 weeks of treatment, ocular inflammation was resolved, best corrected visual acuity was 0.1 (Snellen chart) and intraocular pressure was 18 mm Hg without topical hypotensive therapy. Conclusion: S. spiritivorum was isolated for the first time as a causative agent of endophthalmitis in humans. Bleb needle revision in patients with Xen gel implant is not free of complications, and an attentive follow-up is required.

KW - endophthalmitis

KW - Glaucoma

KW - intraocular pressure

KW - trabeculectomy

KW - Xen gel

UR - http://www.scopus.com/inward/record.url?scp=85074009217&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85074009217&partnerID=8YFLogxK

U2 - 10.1177/1120672119878016

DO - 10.1177/1120672119878016

M3 - Article

C2 - 31552771

AN - SCOPUS:85074009217

JO - European Journal of Ophthalmology

JF - European Journal of Ophthalmology

SN - 1120-6721

ER -