Long-Term Bleb-Related Infections After Trabeculectomy: Incidence, Risk Factors, and Influence of Bleb Revision

American Journal of Ophthalmology
Eun-Ah KimJ Caprioli

Abstract

To report the incidence of late-onset bleb-related infections and to identify risk factors for bleb-related infections after trabeculectomy for the treatment of glaucoma. Retrospective case series. Bleb-related infections were defined as blebitis, endophthalmitis, or blebitis with endophthalmitis. A total of 1959 eyes of 1423 patients who underwent trabeculectomy and who were followed for ≥1 year were included. Twenty-four eyes were diagnosed with bleb-related infections; 15 eyes were found to have blebitis and 9 eyes presented with endophthalmitis during the follow-up period of 5.4 ± 3.5 years (mean ± standard deviation). Among 15 eyes with blebitis, 2 eyes developed endophthalmitis under treatment. The Kaplan-Meier estimated incidence of bleb-related infections was 2.0% ± 0.5% (mean ± standard error) at 10 years. A Cox multivariate analysis showed the significant risk factors for a bleb-related infection to be diagnoses of pigmentary glaucoma or juvenile glaucoma, history of bleb leak, intraocular pressure sustained below the target pressure, chronic blepharitis, and the presence of punctal plugs. Surgical bleb revision demonstrated a protective effect against bleb-related infections (P < .01) when risk factors were present. ...Continue Reading

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