Management of blebitis by members of the American Glaucoma Society: a survey.

PURPOSE: To investigate the practice patterns among glaucoma subspecialists in the American Glaucoma Society regarding the management of blebitis. METHODS: An anonymous survey incorporating 14 questions regarding the management of blebitis was mailed to all current active American Glaucoma Society members, including provisional members, in October 1999. RESULTS: A total of 319 physicians received the survey, and 204 members (64%) returned surveys. Sixty-nine percent of respondents do not ask their patients with functioning blebs to use topical antibiotics at home for early symptoms of blebitis. Thirty-four percent never or almost never obtain conjunctival cultures at the onset of isolated blebitis, whereas 44% always or usually do. Fifty-one percent prescribe a topical fluoroquinolone alone as the initial empirical treatment of isolated blebitis. Twenty-three percent use a fluoroquinolone in combination with one or two other antibiotics. Twenty-one percent choose a combination of fortified topical agents, usually including a fortified aminoglycoside, vancomycin, or cephalosporin. Thirty-one percent use fortified agents in some combination with or without a fluoroquinolone. Five percent prescribe some other single agent alone. Only 6% routinely use an oral antibiotic in cases of blebitis. Sixty-two percent use topical corticosteroids in conjunction with antibiotic treatment. Of these, 68% start them after initial antibiotic treatment is established or once improvement of blebitis is noted. Fifty-six percent indicated that a moderate or severe anterior chamber reaction, including fibrin, would prompt treatment as a possible endophthalmitis. In a persistently Seidel-positive bleb, 77% generally attempt surgical bleb revision. CONCLUSIONS: Methods of the management of blebitis differ among members of the American Glaucoma Society. Treatment recommendations generated from randomized clinical trials are needed.