Propionibacterium acnes Endophthalmitis following Baerveldt Glaucoma Device Implantation

Purpose: The purpose of this study was to report a case of Propionibacterium acnes endophthalmitis in a patient with a Baerveldt glaucoma implant.

Patients and Methods: An 8-year-old boy presented with left eye pain, extreme photophobia, and acute anterior uveitis >6 months after Baerveldt glaucoma implantation. A diagnosis of P. acnes endophthalmitis was made after a positive culture of the explanted Baerveldt device.

Results: Initially, the patient was treated with intravitreal vancomycin and ceftazidime which led to mild early clinical improvement followed by deterioration of findings with recurrence of fibrin at the Baerveldt tube ostium within the anterior chamber. Repeat intravitreal injections were given to include antifungal coverage, along with intracameral moxifloxacin and subconjunctival vancomycin around the Baerveldt reservoir. Symptoms and findings again recurred, ultimately leading to the decision for complete removal of the glaucoma implant along with irrigation of the scleral bed with moxifloxacin. P. acnes was cultured from the extracted implant. The endophthalmitis resolved completely after implant removal.

Conclusions: Despite the introduction of antibiotics into the intravitreal, intracameral, and subconjunctival space surrounding the Baerveldt implant, infection persisted until complete explantation of the device. Early explantation should be considered in glaucoma drainage device endophthamitis secondary to P. acnes.

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Work Title Propionibacterium acnes Endophthalmitis following Baerveldt Glaucoma Device Implantation
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Open Access
Creators
  1. Amanda L. Ely
  2. Kimberly Neely
Keyword
  1. Propionibacterium acnes
  2. Endophthalmitis
  3. Baerveldt
  4. Glaucoma
License In Copyright (Rights Reserved)
Work Type Article
Publisher
  1. Journal of Glaucoma
Publication Date July 2020
Publisher Identifier (DOI)
  1. https://doi.org/10.1097/IJG.0000000000001526
Deposited March 06, 2024

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Version 1
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  • Created
  • Added P_acnes_Baerveldt_J_Glc_Case_Report_2020.pdf
  • Added Creator Amanda L. Ely
  • Added Creator Kimberly Neely
  • Published
  • Updated Work Title Show Changes
    Work Title
    • Propionibacterium acnes endophthalmitis following baerveldt glaucoma device implantation
    • Propionibacterium acnes Endophthalmitis following Baerveldt Glaucoma Device Implantation
  • Updated Keyword, Description, Publication Date Show Changes
    Keyword
    • Propionibacterium acnes, Endophthalmitis, Baerveldt, Glaucoma
    Description
    • <p>Purpose:The purpose of this study was to report a case of Propionibacterium acnes endophthalmitis in a patient with a Baerveldt glaucoma implant.Patients and Methods:An 8-year-old boy presented with left eye pain, extreme photophobia, and acute anterior uveitis &gt;6 months after Baerveldt glaucoma implantation. A diagnosis of P. acnes endophthalmitis was made after a positive culture of the explanted Baerveldt device.Results:Initially, the patient was treated with intravitreal vancomycin and ceftazidime which led to mild early clinical improvement followed by deterioration of findings with recurrence of fibrin at the Baerveldt tube ostium within the anterior chamber. Repeat intravitreal injections were given to include antifungal coverage, along with intracameral moxifloxacin and subconjunctival vancomycin around the Baerveldt reservoir. Symptoms and findings again recurred, ultimately leading to the decision for complete removal of the glaucoma implant along with irrigation of the scleral bed with moxifloxacin. P. acnes was cultured from the extracted implant. The endophthalmitis resolved completely after implant removal.Conclusions:Despite the introduction of antibiotics into the intravitreal, intracameral, and subconjunctival space surrounding the Baerveldt implant, infection persisted until complete explantation of the device. Early explantation should be considered in glaucoma drainage device endophthamitis secondary to P. acnes.</p>
    • <p>Purpose: The purpose of this study was to report a case of _Propionibacterium acnes_ endophthalmitis in a patient with a Baerveldt glaucoma implant.
    • Patients and Methods: An 8-year-old boy presented with left eye pain, extreme photophobia, and acute anterior uveitis &gt;6 months after Baerveldt glaucoma implantation. A diagnosis of _P. acnes_ endophthalmitis was made after a positive culture of the explanted Baerveldt device.
    • Results: Initially, the patient was treated with intravitreal vancomycin and ceftazidime which led to mild early clinical improvement followed by deterioration of findings with recurrence of fibrin at the Baerveldt tube ostium within the anterior chamber. Repeat intravitreal injections were given to include antifungal coverage, along with intracameral moxifloxacin and subconjunctival vancomycin around the Baerveldt reservoir. Symptoms and findings again recurred, ultimately leading to the decision for complete removal of the glaucoma implant along with irrigation of the scleral bed with moxifloxacin. P. acnes was cultured from the extracted implant. The endophthalmitis resolved completely after implant removal.
    • Conclusions: Despite the introduction of antibiotics into the intravitreal, intracameral, and subconjunctival space surrounding the Baerveldt implant, infection persisted until complete explantation of the device. Early explantation should be considered in glaucoma drainage device endophthamitis secondary to _P. acnes_.</p>
    Publication Date
    • 2020-07-01
    • 2020-07
  • Updated Description Show Changes
    Description
    • <p>Purpose: The purpose of this study was to report a case of _Propionibacterium acnes_ endophthalmitis in a patient with a Baerveldt glaucoma implant.
    • Patients and Methods: An 8-year-old boy presented with left eye pain, extreme photophobia, and acute anterior uveitis &gt;6 months after Baerveldt glaucoma implantation. A diagnosis of _P. acnes_ endophthalmitis was made after a positive culture of the explanted Baerveldt device.
    • Results: Initially, the patient was treated with intravitreal vancomycin and ceftazidime which led to mild early clinical improvement followed by deterioration of findings with recurrence of fibrin at the Baerveldt tube ostium within the anterior chamber. Repeat intravitreal injections were given to include antifungal coverage, along with intracameral moxifloxacin and subconjunctival vancomycin around the Baerveldt reservoir. Symptoms and findings again recurred, ultimately leading to the decision for complete removal of the glaucoma implant along with irrigation of the scleral bed with moxifloxacin. P. acnes was cultured from the extracted implant. The endophthalmitis resolved completely after implant removal.
    • Results: Initially, the patient was treated with intravitreal vancomycin and ceftazidime which led to mild early clinical improvement followed by deterioration of findings with recurrence of fibrin at the Baerveldt tube ostium within the anterior chamber. Repeat intravitreal injections were given to include antifungal coverage, along with intracameral moxifloxacin and subconjunctival vancomycin around the Baerveldt reservoir. Symptoms and findings again recurred, ultimately leading to the decision for complete removal of the glaucoma implant along with irrigation of the scleral bed with moxifloxacin. _P. acnes_ was cultured from the extracted implant. The endophthalmitis resolved completely after implant removal.
    • Conclusions: Despite the introduction of antibiotics into the intravitreal, intracameral, and subconjunctival space surrounding the Baerveldt implant, infection persisted until complete explantation of the device. Early explantation should be considered in glaucoma drainage device endophthamitis secondary to _P. acnes_.</p>
  • Updated