The incidence, clinical features, microbiology, and visual outcomes of endophthalmitis associated with glaucoma surgery in children

Abdullah T Al Zahrani; Nouf A AlZendi; Sulaiman M Alsulaiman; Sami AlShahwan; Mohammad Aatif Khan; Rizwan Malik

doi:10.1016/j.jaapos.2025.104114

The incidence, clinical features, microbiology, and visual outcomes of endophthalmitis associated with glaucoma surgery in children

J AAPOS. 2025 Jan 23:104114. doi: 10.1016/j.jaapos.2025.104114. Online ahead of print.

Authors

Abdullah T Al Zahrani¹, Nouf A AlZendi¹, Sulaiman M Alsulaiman², Sami AlShahwan³, Mohammad Aatif Khan⁴, Rizwan Malik¹

Affiliations

¹ Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
² Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
³ Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. Electronic address: sshahwan@kkesh.med.sa.
⁴ Microbiology Laboratory, King Abdullah bin Abdulaziz University Hospital, Princess Norah University, Riyadh, Saudi Arabia.

PMID: 39863266
DOI: 10.1016/j.jaapos.2025.104114

Abstract

Purpose To study the incidence, clinical features, microbiology, and visual outcome of endophthalmitis associated with glaucoma surgery in children at a tertiary care eye hospital in Saudi Arabia. Methods The medical records of patients <18 years of age who presented with endophthalmitis following glaucoma surgery between January 2008 and October 2018 were reviewed retrospectively. Results Endophthalmitis after glaucoma surgery was observed in 20 eyes, or 18 out of 853 eyes that underwent glaucoma surgery at our institution (2.1%; 3.3% for glaucoma drainage device [GDD] surgery and 0.9% for glaucoma filtration surgery [GFS]). The mean patient age at time of endophthalmitis was 5.2 ± 4 years (range, 1-15 years). Delayed endophthalmitis (developing at least 6 weeks after surgery) occurred in 13 of the 20 eyes (65%). The median interval between glaucoma surgery and the development of endophthalmitis was shorter after GDD surgery (59 days; range, 26-1325) compared with GFS (606 days; range, 20-2190). Visual outcome was generally poor, with counting fingers or worse in 14 of 20 eyes (70%). A causative organism was identified in 16 of 20 eyes (80%) either through a vitreous tap or vitrectomy specimen, and the most cultured organism was Streptococcus pneumoniae (45%). Conclusions In our study cohort, the incidence of endophthalmitis after GFS was 0.9% and 3.3% after GDD implant surgery; the incidence was higher than previously reported in adults, with poor long-term visual prognosis in the pediatric age group.