Changing trends in the incidence of bleb-related infection in trabeculectomy. Issue 7 (14th February 2012)

• Record Type: Journal Article
• Authors: Rai, Poornima; Kotecha, Aachal; Kaltsos, Konstantinos; Ruddle, Jonathan B; Murdoch, Ian E; Bunce, Catey; Barton, Keith
• Is Part Of: British journal of ophthalmology. Volume 96:Issue 7(2012)
• Page Start: 971
• Page End: 975
• Publication Date: 2012-02-14
• Subjects: Glaucoma -- imaging -- medical education -- rehabilitation -- field of vision -- optic nerve -- treatment medical -- child health (paediatrics) -- genetics -- electrophysiology -- treatment surgery -- telemedicine -- clinical trial -- epidemiology; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjophthalmol-2011-300926
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : Aim: To investigate the incidence of late onset bleb-related infection (BRI) following Mitomycin C (MMC) augmented trabeculectomy procedures at a single institution. Methods: This was a retrospective case series analysis of late onset BRI, defined as either blebitis or endophthalmitis occurring at least 1 month following a glaucoma filtration procedure. Data collected from hospital charts included the position of the conjunctival flap base. Two cohorts were examined: the first a sample of 194 intraoperative MMC augmented trabeculectomies undertaken over a 4-year period from 1993 to 1997, and the second a sample of 764 MMC trabeculectomies performed in a 4-year period between the years 1999 and 2005. Results: A total of 11 cases of BRI (cumulative incidence 5.7%) were identified in the cohort from 1993 to 1997. BRI cases had trabeculectomies performed with a limbus-based conjunctival flap and presented at a median IQR 14.8 (9.4–42.9) months after surgery. In the 1999–2005 cohort, nine cases of BRI were identified (cumulative incidence 1.2%). All these BRI cases had a fornix-based conjunctival flap and presented at a median IQR 19.2 (6.1–44.1) months after trabeculectomy surgery. Conclusion: This study found that the incidence of BRI was higher in MMC augmented trabeculectomy shortly after the introduction of MMC, but subsequently reduced to a lower level. While many changes in surgical technique had occurred in the intervening period, the most significant change was from limbus-based to fornix-based conjunctival flap. However, the retrospective nature of the study prevents the authors from concluding that there is a causative relationship between changes in surgical technique and BRI.