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Karolina Chmielewska, Jean-Louis Anctil, Louis Caron, Caroline Lajoie, Annie Goyette, Béatrice DesMarchais; Factors Leading to Surgical Revision of Bleb Leaks: a Retrospective Case-control Study. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2501.
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Bleb leak following a trabeculectomy is a serious complication presenting days, months or even years after the surgery. With the use of antimetabolite agents to increase bleb survival, more blebs have a thin and fragile conjunctiva with secondary leak. This retrospective study was designed to describe the population at risk of having a bleb leak needing a repair in the operating room and to study some factors associated with this complication.
We studied all patients having a surgical revision in our center for a bleb leak between January 1st and December 30, 2008. Three controls were paired to each case based on their surgery date (more or less 2 months). We then analyzed risk factors related to the patient, the intervention and the postoperative follow-up.
Time of administration of mitomycin C did not show any influence on the risk. Number of topical medications prior to surgery, type of surgery, localization of the wound and manipulations in the follow-up period were all factors that did not show a significant difference between our two groups. Surprisingly, younger age was a statistically significant risk factor (p=0.0061) in our study. In fact, patients younger than 55 had an odds ratio of 21 compared to those aged 75 or more. The risk decreased linearly following age in the 55-74 years old population (p=0.0029).
Younger age, particularly in age under 55, might be a risk factor for developing a bleb leak following trabeculectomy. Those patients should be monitored closely in their postoperative period. Per- and post-operative manipulations do not seem to increase the risk for a severe leak in this study, as neither does time of application of mitomycin C.
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