Estimating the Rate of Bullous Internal Limiting Membrane Separation After Endophthalmitis

Document Type

Conference Proceeding

Publication Date


Publication Title

Investigative Ophthalmology and Visual Science


Purpose : To describe and report the incidence of spontaneous internal limiting membrane (ILM) separation after an episode of endophthalmitis.

Methods : A retrospective review of the electronic health record was performed to identify cases of endophthalmitis (ICD 10 code H44.01 and H44.02). Next, a review of the associated spectral domain optical coherence tomography (SD-OCT) imaging was performed for each case of endophthalmitis. The presence or absence of the “bucket handle” sign was noted to identify the rate of ILM separation. An in-depth chart review was performed for positive cases to identify the initial treatment, the causal organism and the duration of bucket handle stability. Cases without adequate imaging or those of endogenous endophthalmitis were excluded.

Results : Upon initial review, 29 cases of endophthalmitis were identified. Of these 3 cases demonstrated the “bucket handle” sign, signifying spontaneous ILM separation occurring at a rate of 10.3%. In the three cases initial treatment was a tap and inject with vancomycin and ceftazidime. In all three cases the causative bacterial organism was staph epidermidis. In 2 of 3 cases, there was stability of the bucket handle, however in the third case progressive vitreoretinal traction occurred.

Conclusions : This pilot study adds to the growing body of knowledge surrounding spontaneous ILM separation after endophthalmitis. Our preliminary results suggest that the rate of ILM separation after endophthalmitis is approximately 10%. Given our small sample size, additional research is currently underway to better understand the true incidence of the post-endophthalmitis “bucket handle” sign. Further research will aim to better understand the pathophysiological mechanisms which underly spontaneous ILM separation as this understanding may parlay into potentially clinically relevant therapeutic options for vitreoretinal interface disease





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Annual Meeting Association for Research in Vision and Ophthalmology, ARVO 2023, April 23-27, 2023, New Orleans, LA