# Early-Onset Methicillin-Resistant Staphylococcus aureus Blebitis Following PRESERFLO™ MicroShunt Implantation: A Case Report

## TL;DR

A rare case of early-onset infection caused by MRSA following a glaucoma implant highlights the risk of resistant pathogens despite standard care.

## Contribution

Reports a rare case of MRSA blebitis after PRESERFLO™ MicroShunt implantation, emphasizing the risk of resistant infections.

## Key findings

- MRSA caused early-onset blebitis despite routine antibiotic prophylaxis after PMS implantation.
- Infection led to tube exposure and required PMS removal and bleb revision.
- Visual acuity and intraocular pressure stabilized after treatment.

## Abstract

We describe a rare case of early-onset bleb-related infection (BRI) caused by methicillin-resistant Staphylococcus aureus (MRSA) following implantation of the PRESERFLO™ MicroShunt (PMS; Santen Pharmaceutical, Osaka, Japan). A 70-year-old female with bilateral primary open-angle glaucoma, pseudophakia, and a 15-year history of glaucoma treatment underwent PMS implantation in her left eye. On postoperative day (POD) 25, blebitis was observed, characterized by conjunctival hyperemia, mucopurulent discharge, and eyelid swelling, despite routine postoperative prophylaxis with topical antibiotics. A positive Seidel test result was also observed. Initial management with intensive topical antibiotics was followed by intracameral vancomycin and ceftazidime on POD 27 due to the condition worsening. Cultures of conjunctival discharge grew MRSA, prompting intensive topical and systemic vancomycin therapy, along with levofloxacin. Although ocular inflammation improved, tube exposure occurred on POD 32, necessitating PMS removal and bleb revision. Two months later, the conjunctiva was completely healed, Best-corrected visual acuity (BCVA) was 1.0, and intraocular pressure stabilized at 16 mmHg with a single medication and without any residual sequelae.

Although PMS implantation is generally associated with fewer bleb-related complications than traditional trabeculectomy, early postoperative BRI may occur, particularly in the presence of bleb leakage. This report highlights that resistant organisms, such as MRSA, can cause severe infection even under standard postoperative prophylaxis, and that clinicians should maintain strict follow-up observation for early signs of infection after PMS implantation and consider the possibility of resistant pathogens to ensure timely and effective management.