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S. Sharan, G. E. Trope, Y. M. Buys; Rate Of Blebitis/Late Onset Endophthalmitis Post Glaucoma Filtration Surgery. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5671.
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The literature reports a rate of blebitis/late onset endophthalmitis of 1-6% at 2-6 years post filtration surgery. Our objective was to study the rate and course of blebitis/late onset endophthalmitis 5-10 years post filtration surgery and to evaluate risk factors.
Retrospective chart review of consecutive patients undergoing filtration surgery (trabeculectomy, phacotrabeculectomy and Setons) by one surgeon (YMB) from Jan 1, 1996 to Dec 31, 2001. Data recorded included patient demographics, glaucoma type, procedure details, use of antimetabolites, bleb leaks and manipulations, visual acuity, intraocular pressure and functionality of the bleb post infection.
During the study period 455 eyes of 350 patients (43.6% males and 56.4% females) underwent 522 surgeries. 71.5% were Caucasian and 11.1% Black. 40% had primary open angle glaucoma and 24% were diabetic. Mean age at surgery was 65.2 years (16.9-90.6). Follow-up ranged from 4.7 - 10.8 years. For all surgeries (preinfection) 30.1% underwent suture lysis, 5.2% of blebs developed leak and 1.72% blebs underwent surgical repair.There were a total of 5 (1.3%) bleb related infections, 4 blebitis and 1 endophthalmitis, occurring 3 weeks to 78 months post surgery (mean 31.3 months). There were 3 males and 2 females, with a mean age at surgery of 53.4 years (27-80). 3 were Black and 2 Caucasian. 3 had primary open angle glaucoma, 1 low tension and 1 mixed mechanism glaucoma. 2 had multiple surgeries. All 5 underwent trabeculectomies with a superior fornix based conjunctival flap. Mitomycin C was used in all except 1. Preinfection, 4 underwent suture lysis, bleb leaks were seen in 4, 3 underwent surgical revision and 1 autologous blood injection. 2 had hypotony before and after the infection. Vision dropped in 1 after infection. The bleb remained functional in 3 after infection. Treatment included intravitreal antibiotics and fortified antibiotic drops and in one case a vitrectomy.
We found 5 (1.3%) cases of bleb related infections in 522 filtration surgeries with a maximum of 10.8 years follow-up. Black race, antimetabolites, bleb manipulation, multiple surgeries, bleb leaks and hypotony were important risk factors. Diabetes mellitus was not an important risk factor.
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