**12. Bleb-related endophthalmitis**

Bleb-related endophthalmitis usually follows a chronic course of infection (Figure 8). In these infections, commonest causative organisms are Streptococcus species and Gram-nega‐ tive bacteria, especially Haemophilus influenzae. [29] Because of the existing history of glau‐ coma, visual prognosis in these cases is expected to be poor requiring early aggressive intervention. [3] These patients require immediate vitrectomy along with intra-vitreal antibi‐ otic injection. These patients may also require systemic antibiotics. Most frequent causative organisms isolated in cases of delayed-onset bleb-related endophthalmitis include, Strepto‐ coccus species, Enterococcus and Gram-negative bacteria. [29] A retrospective consecutive case series of delayed-onset bleb-associated endophthalmitis seen at Bascom Palmer Eye In‐ stitute over a 14 year period identified 86 eyes of 85 patients from which 63% eyes were cul‐ ture-positive. [50] The most common organisms recovered from cultures among these patients were: Streptococcus, 25%; Gram-negative, 18%; coagulase-negative Staphylococcus, 11%; Enterococcus, 7%; Moraxella, 10%; Pseudomonas, 4%; and Serratia, 4%. This large study revealed that culture-positive cases were associated with worse presenting visual acuity, higher presenting intraocular pressure, and worse visual outcomes than culture-neg‐ ative cases. Streptococcus, Pseudomonas, and Serratia cases were associated with poor pre‐ senting view of the fundus and worse visual outcomes than coagulase-negative Staphylococcus and Moraxella cases. [50] Worse view of the fundus in the Streptococcus cas‐ es likely compelled the treating clinician to more frequently favor PPV.
