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J. C. Clarke, P. T. Khaw; The Incidence of Bleb Related Infections Following Trabeculectomy and the Influence of Bleb Morphology. Invest. Ophthalmol. Vis. Sci. 2010;51(13):621.
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Bleb related infections (BRIs) potentially result in severe loss of vision and are a complication of drainage surgery. Antimetabolites are implicated as risk factors for future infections and the annual incidence is 02-9.6% in the literature. Intraoperative 5FU has a beneficial influence on IOP following trabeculectomy. This study quantifies the influence of central bleb morphology and the incidence of BRIs.
The blebs of 367 patients who had undergone primary, limbal based trabeculectomy, either with or without 5FU, were photographed over a minimum of 3 years at regular intervals. The bleb morphology was graded by masked observers with the Moorfields Bleb Grading System. Patients’ blebs were photographed at each of their planned postoperative visits.
367 patients were followed up for a mean period of 5.5 years. Eight patients developed blebitis and 3 developed bleb related endophthalmitis. The annual incidence of BRIs is 0.59%. Patients treated with intraoperative 5FU developed 4 (2.2%) cases of blebitis and 3 (1.7%) cases of endophthalmitis. Patients not treated with antimetabolite did not develop any cases of endophthalmitis and 4 (2.2%) cases of blebitis. 2 (50%) of the 4 affected unaugmented trabeculectomies had failed and required redo trabeculectomy with mitomycin-c prior to developing blebitis.Blebs were graded as cystic or avascular in 10 of the 12 (83%) of the BRIs. Blebs were described clinically as leaking or sweating in 9 of the 12 (75%) of the cases. The extrapolated annual incidence of BRIs in the 135 avascular and cystic blebs (as graded at 1 year postoperative) is 1.35%.
BRIs are rare and potentially serious consequences of trabeculectomy with an annual incidence of 0.59%. This increases to 1.35% if the central zone of the bleb is graded as cystic or avascular. 83% of blebs are cystic or avascular prior to BRI and 75% are described clinically as leaking or sweating.
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