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

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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.

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Authors and Affiliations

  1. Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstrasse 5, 79106, Freiburg, Germany

    J. Luebke, T. Wecker, D. Boehringer, B. Cakir, T. Reinhard & A. Anton

  2. Augenärztliche Gemeinschaftspraxis Dr. Neuburger – Burau – Dr. Schmidt, Achern, Germany

    M. Neuburger

  3. Vobig & Jordan, Fachärzte für Augenheilkunde, Frankfurt, Germany

    J. F. Jordan

Authors
  1. J. Luebke
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  2. M. Neuburger
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  3. J. F. Jordan
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  4. T. Wecker
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  5. D. Boehringer
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  6. B. Cakir
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  7. T. Reinhard
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Correspondence to J. Luebke.

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Conflict of interest

None of the authors has any financial or proprietary interest in any of the materials or methods mentioned.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was not needed due to the retrospective nature of the study (confirmed by the local ethics committee, Vote No. 226/15).

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Luebke, J., Neuburger, M., Jordan, J.F. et al. Bleb-related infections and long-term follow-up after trabeculectomy. Int Ophthalmol 39, 571–577 (2019). https://doi.org/10.1007/s10792-018-0851-0

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