Abstract
Purpose :
A clinical challenge with the trabeculectomy and other types of pressure lowering surgery is the excessive wound healing, which leads often to an increased postoperative IOP due to a blockage of the surgical fistula. A needle procedure (NP) is used to reestablish free flow of aqueous humor from the anterior chamber to the subconjunctival bleb space by cutting through postoperative scar tissue that prevents or decreases aqueous outflow. The peri-operative supplementation of antifibrotic agents optimizes effectiveness of trabeculectomy and needling. A diversity of complications has been described to the NP. The purpose of this study is to describe for the first time a series of preseptal celulitis cases associated to mitomycin-C (MMC) supplemented needling to manage failing filtering blebs after trabeculectomy.
Methods :
After a retrospective search of an electronic medical record database of 561 consecutive trabeculectomies performed in a single glaucoma center from November 2017 to October 2022, a series of nine cases with clinical findings compatible with preseptal cellulitis after a MMC-supplemented NP done for rescuing failing post-trabeculectomy blebs were analyzed.
Results :
A series of 9 cases (6 female / 3 male) with a median age of 25 years (range, 6-66 years) presented with clinical signs of preseptal celulitis (with no fever and minimal increased in periocular skin temperature) that solved in a median time of 7 days (range, 3-21 days) with a scheme of steroidal topical and non-steroidal oral antiinflamatory, plus cold compresses applied over the affected area. No systemic signs / symptoms were present. Neither external periocular nor ocular consequences were recorded. In the short-term (6 months) most MMC- supplemented NP were succesful to reduce significantly the IOP in all cases (median pre-NP, 32 mm Hg; range, 20-43 mm Hg; median post-NP, 14 mm Hg; range, 8-16 mm Hg; p = 0.0076). In table 1, demographic and general data are shown.
Conclusions :
Non-infectious preseptal cellulitis cases associated to MMC-supplemented NP after trabeculectomy have not been previously reported. The course of such complication had a bening behavior and resolved with minimal pharmacological intervention not requiring an antibiotic. Although this uncommon condition can be attributed to MMC supplementation, other causes have to be investigated
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.