Fulminant bleb-associated endophthalmitis caused by Streptococcus dysgalactiae successfully managed with endoscope-assisted vitrectomy: a case report

Abstract Purpose To describe a rare case of bleb-associated endophthalmitis caused by Streptococcus dysgalactiae and its successful management using endoscope-assisted vitrectomy combined with bleb repair. Case presentation A patient presented with light perception vision and elevated intraocular pressure following prior glaucoma surgery. Examination revealed a massive hypopyon, a leaking avascular bleb with uveal incarceration, and a severe vitreous abscess. Due to profound media opacities precluding conventional visualization, the patient underwent an endoscope-assisted vitrectomy (EAV). The necrotic bleb was debrided, and the fistula was sealed using a mobilized conjunctival flap. Vitreous cultures isolated S. dysgalactiae . Results Postoperatively, the intraocular infection was completely eradicated. At the 1-month follow-up, the superior conjunctival graft remained intact and well-perfused with no signs of bleb leakage, although visual recovery was limited by persistent corneal infiltration. Conclusion S. dysgalactiae can precipitate fulminant BAE with rapid intraocular destruction. When severe anterior segment media opacification is present, EAV serves as a crucial and definitive surgical intervention to clear the infectious load and facilitate concurrent bleb repair.