A Review on Pathogens and Necessary Diagnostic Work for Bleb-Related Infections (BRIs)

Abstract

At the present time, as newer techniques and minimally invasive procedures gain popularity among anterior segment surgeons for regulating intraocular pressure, trabeculectomy still has a leading role in glaucoma surgery. Trabeculectomy retains a highly successful and safe profile; however, one of the major complications includes bleb-related infections (BRIs). To date, the most common pathogens remain Gram-positive cocci, but the list of pathogens that have been identified in the literature includes more than 100 microorganisms. Because antibiotic use is more widespread than ever before and our ability to identify pathogens has improved, the pathogen spectrum will broaden in the future and more pathogens causing BRIs will be described as atypical presentations. The scope of this review was to identify all pathogens that have been described to cause bleb-related infections to date, as well as focus on the risk factors, clinical presentation, and various available diagnostic tools used for an appropriate diagnostic workup.

A Brief Review of Historical and Current Trends in Trabeculectomy

“…BRIs BRIs are the most dreaded post-trabeculectomy complications given their potential for causing rapid and devastating vision loss. BRI is classified into 3 stages [141][142][143] with stage III defined as BRE.…”

“…BRIs are the most dreaded post-trabeculectomy complications given their potential for causing rapid and devastating vision loss. BRI is classified into 3 stages 141–143 with stage III defined as BRE. Stage I: purulence or mucopurulent discharge and conjunctival injection localized to the bleb. Stage II: stage I findings with evidence of cells, flare, or hypopyon in the anterior chamber. Stage IIIa: mild vitreous involvement with a visible fundus and no opacity on B-mode ultrasonography. Stage IIIb: marked vitreous involvement without visibility of the fundus and significant opacities on B-mode ultrasonography. …”