Top

International Ophthalmology

Published in:

01-03-2019 | Original Paper

Bleb-related infections and long-term follow-up after trabeculectomy

Authors: J. Luebke, M. Neuburger, J. F. Jordan, T. Wecker, D. Boehringer, B. Cakir, T. Reinhard, A. Anton

Published in: International Ophthalmology | Issue 3/2019

Abstract

Purpose

Bleb-related infections are serious complications after trabeculectomy. They can be limited to the bleb or disseminate and lead to endophthalmitis. We herein report on all bleb-related infections that have been diagnosed at the Eye Center of the University of Freiburg, Germany, since 1999.

Methods

We reviewed a total of 1816 consecutive trabeculectomies that were performed at our hospital between the years 1999 and 2014 (353 without and 1463 with intraoperative application of mitomycin C). All bleb-related infections that were diagnosed at our clinic during the same period were included in the analysis. We fitted a Cox proportional hazards model to characterize risk factors for bleb-related infections.

Results

We diagnosed a total of 19 bleb-related infections in this period. Three patients with bleb-related infections that came to our clinic had their trabeculectomy performed elsewhere. The overall percentage of bleb-related infections was 0.1% after 2 years (Kaplan–Meier estimate at median follow-up). Nine eyes suffered from only localized infection of the bleb. Seven eyes developed endophthalmitis. Four infections occurred during the first postoperative month. The median age on the day of diagnosis was 71 years; the median age at surgery was 69 years. In the Cox model, intraoperative application of mitomycin C and a fornix-based conjunctival flap were identified as significant risk factors (hazard ratio: 79.02, 4.69; p < 0.01, p < 0.01). The whole group showed a reduction of visual acuity in the median from logMAR 0.12 to 0.2. Eyes that suffered from endophthalmitis showed a loss from 0.3 to 0.96, while the localized infections had a reduction from 0.04 to 0.07.

Conclusion

Bleb-related infections are a rare complication following trabeculectomy and can be localized on the bleb or can lead to endophthalmitis, thereby threatening visual acuity. The risks and benefits of mitomycin C-augmented trabeculectomies should be taken into consideration.

Chen CW, Huang HT, Bair JS, Lee CC (1990) Trabeculectomy with simultaneous topical application of mitomycin-C in refractory glaucoma. J Ocul Pharmacol 6:175–182CrossRefPubMed

Rothman RF, Liebmann JM, Ritch R (2000) Low-dose 5-fluorouracil trabeculectomy as initial surgery in uncomplicated glaucoma: long-term followup1. Ophthalmology 107:1184–1190. https://doi.org/10.1016/S0161-6420(00)00085-3 CrossRefPubMed

Reinhard T, Klüppel M, Sundmacher R (1993) 5-Fluorouracil-injektionsbehandlung nach fistulierenden Glaukomoperationen. Klin Monatsblätter Für Augenheilkd 203:329–335. https://doi.org/10.1055/s-2008-1045686 CrossRef

Solomon A, Ticho U, Frucht-Pery J (1999) Late-onset, bleb-associated endophthalmitis following glaucoma filtering surgery with or without antifibrotic agents. J Ocul Pharmacol Ther 15:283–293CrossRefPubMed

Katz LJ, Cantor LB, Spaeth GL (1985) Complications of surgery in glaucoma. Early and late bacterial endophthalmitis following glaucoma filtering surgery. Ophthalmology 92:959–963CrossRefPubMed

Mochizuki K, Jikihara S, Ando Y et al (1997) Incidence of delayed onset infection after trabeculectomy with adjunctive mitomycin C or 5-fluorouracil treatment. Br J Ophthalmol 81:877–883CrossRefPubMedPubMedCentral

Freedman J, Gupta M, Bunke A (1978) Endophthalmitis after trabeculectomy. Arch Ophthalmol Chic Ill 1960 96:1017–1018CrossRef

Ticho U, Ophir A (1993) Late complications after glaucoma filtering surgery with adjunctive 5-fluorouracil. Am J Ophthalmol 115:506–510CrossRefPubMed

Uchida S, Suzuki Y, Araie M et al (2001) Long-term follow-up of initial 5-fluorouracil trabeculectomy in primary open-angle glaucoma in Japanese patients. J Glaucoma 10:458–465CrossRefPubMed

10.

Greenfield DS, Suñer IJ, Miller MP et al (1996) Endophthalmitis after filtering surgery with mitomycin. Arch Ophthalmol Chic Ill 1960 114:943–949CrossRef

11.

Yamamoto T, Sawada A, Mayama C et al (2014) The 5-year incidence of bleb-related infection and its risk factors after filtering surgeries with adjunctive mitomycin C: collaborative bleb-related infection incidence and treatment study 2. Ophthalmology 121:1001–1006. https://doi.org/10.1016/j.ophtha.2013.11.025 CrossRefPubMed

12.

DeBry PW, Perkins TW, Heatley G et al (2002) Incidence of late-onset bleb-related complications following trabeculectomy with mitomycin. Arch Ophthalmol 120:297–300. https://doi.org/10.1001/archopht.120.3.297 CrossRefPubMed

13.

Shigeeda T, Tomidokoro A, Chen Y-N et al (2006) Long-term follow-up of initial trabeculectomy with mitomycin C for primary open-angle glaucoma in Japanese patients. J Glaucoma 15:195–199. https://doi.org/10.1097/01.ijg.0000212202.57029.45 CrossRefPubMed

14.

Lehmann OJ, Bunce C, Matheson MM et al (2000) Risk factors for development of post-trabeculectomy endophthalmitis. Br J Ophthalmol 84:1349–1353. https://doi.org/10.1136/bjo.84.12.1349 CrossRefPubMedPubMedCentral

15.

Yassin SA (2015) Bleb-related infection revisited: a literature review. Acta Ophthalmol (Copenh). https://doi.org/10.1111/aos.12805 CrossRef

16.

Soltau JB, Rothman RF, Budenz DL et al (2000) Risk factors for glaucoma filtering bleb infections. Arch Ophthalmol Chic Ill 1960 118:338–342CrossRef

17.

Busbee BG, Recchia FM, Kaiser R et al (2004) Bleb-associated endophthalmitis: clinical characteristics and visual outcomes. Ophthalmology 111:1495–1503. https://doi.org/10.1016/j.ophtha.2004.01.028 (discussion 1503) CrossRef

18.

Ye H, Sun X, Gan D et al (2012) Bleb-associated endophthalmitis in a Chinese population (2003–2010): clinical characteristics and visual outcome. Eur J Ophthalmol 22:719–725. https://doi.org/10.5301/ejo.5000110 CrossRefPubMed

19.

Al Rashaed S, Arevalo FM, Sulaiman SA et al (2016) Endophthalmitis trends and outcomes following glaucoma surgery at a tertiary eye care hospital in Saudi Arabia. J Glaucoma. https://doi.org/10.1097/ijg.0000000000000261 CrossRefPubMed

20.

Kinast RM, Akula KK, Mansberger SL et al (2015) Concentration accuracy of compounded mitomycin c for ophthalmic surgery. JAMA Ophthalmol. https://doi.org/10.1001/jamaophthalmol.2015.4970 CrossRef

21.

Alwitry A, King AJ (2012) Surveillance of late-onset bleb leak, blebitis and bleb-related endophthalmitis—a UK incidence study. Graefes Arch Clin Exp Ophthalmol 250:1231–1236. https://doi.org/10.1007/s00417-011-1920-5 CrossRefPubMed

22.

Rai P, Kotecha A, Kaltsos K et al (2012) Changing trends in the incidence of bleb-related infection in trabeculectomy. Br J Ophthalmol 96:971–975. https://doi.org/10.1136/bjophthalmol-2011-300926 CrossRefPubMed

23.

Kuroda U, Inoue T, Awai-Kasaoka N et al (2014) Fornix-based versus limbal-based conjunctival flaps in trabeculectomy with mitomycin C in high-risk patients. Clin Ophthalmol Auckl NZ 8:949–954. https://doi.org/10.2147/OPTH.S61342 CrossRef

24.

Sharan S, Trope GE, Chipman M, Buys YM (2009) Late-onset bleb infections: prevalence and risk factors. Can J Ophthalmol J Can Ophtalmol 44:279–283. https://doi.org/10.3129/i09-050 CrossRef

25.

Kim E-A, Law SK, Coleman AL et al (2015) Long-term bleb-related infections after trabeculectomy: incidence, risk factors and influence of bleb revision. Am J Ophthalmol. https://doi.org/10.1016/j.ajo.2015.03.001 CrossRefPubMed

26.

Solborg Bjerrum S (2015) Quality assessment of cataract surgery in Denmark—risk of retinal detachment and postoperative endophthalmitis. Acta Ophthalmol (Copenh) 93:391–392. https://doi.org/10.1111/aos.12760 CrossRef

27.

Gower EW, Keay LJ, Stare DE et al (2015) Characteristics of endophthalmitis after cataract surgery in the United States medicare population. Ophthalmology 122:1625–1632. https://doi.org/10.1016/j.ophtha.2015.04.036 CrossRefPubMedPubMedCentral

Title: Bleb-related infections and long-term follow-up after trabeculectomy
Authors: J. Luebke
M. Neuburger
J. F. Jordan
T. Wecker
D. Boehringer
B. Cakir
T. Reinhard
A. Anton
Publication date: 01-03-2019
Publisher: Springer Netherlands
Published in: International Ophthalmology / Issue 3/2019
Print ISSN: 0165-5701
Electronic ISSN: 1573-2630
DOI: https://doi.org/10.1007/s10792-018-0851-0

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Bleb-related infections and long-term follow-up after trabeculectomy

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2019

Retinal single-layer analysis with optical coherence tomography shows inner retinal layer thinning in Huntington’s disease as a potential biomarker

Phacoemulsification cataract surgery in patients receiving novel oral anticoagulant medications

Validation of the structure–function correlation report from the heidelberg edge perimeter and spectral-domain optical coherence tomography

Acquired myopia in Vogt–Koyanagi–Harada disease

Damage to the inferior oblique muscle branch of the oculomotor nerve: a complication during orbital fat decompression

Acknowledgement to our reviewers 2018