Endophthalmitis and severe blebitis following trabeculectomy. Epidemiology and risk factors; a single‐centre retrospective study

Abstract

ABSTRACT.Purpose: To study the epidemiology and risk factors of early-and late-onset postoperative endophthalmitis (PE) and severe blebitis following trabeculectomy. Methods: Retrospective, single-centre, observational study with a case-control design in part. Patients sustaining PE and severe blebitis following trabeculectomy or a combined trabeculectomy with a cataract extraction procedure performed from 1990 through 2008 and diagnosed from 1990 through 2012 were recorded at St Erik Eye Hospital. Incidence data were calculated with help from the hospital records. Notes data of cases and of six randomly selected but procedure matched control patients for each case were compared. Results: The joint rate of infection was 0.46% or 34 incidents in 7402 procedures. The frequency of early (occurring <6 weeks after surgery) onset PE was 0.19%, late PE was 0.19% and severe blebitis was 0.08%. Dominating aetiologies were staphylococci and streptococci. Overall, the infection severely impaired the visual function. Combined cataract and fistulating operations were less prone to develop late infections, p = 0.04, but no other decisive factors were identified in the case-control study. Data collection for all trabeculectomy surgeries from 1998 and onward identified an increased rate for late infection with the use of mitomycin C (MMC), 8 in 1171 surgeries or 0.7%, versus no such use, 0 case of late PE in 2136 surgeries, p < 0.001. Conclusions: Postoperative endophthalmitis is a devastating complication after trabeculectomy. The use of MMC increases the risk for delayed infection. Early PE after trabeculectomy is clearly more common than PE after cataract surgery. Developing efficacious prophylactic antibiotic regimens to reduce early PE after penetrating filtering procedures should be a major priority in ophthalmic surgery.

Trabeculectomy versus canaloplasty (TVC study) in the treatment of patients with open‐angle glaucoma: a prospective randomized clinical trial

“…Severe bleb-related infections, blebitis and endophthalmitis are rare but serious visionthreatening complications after trabeculectomy (Yamamoto et al 2013). In particular, the use of intraoperative MMC leading to thin-walled filtering blebs is a risk factor of blebitis and associated endophthalmitis (Wallin et al 2013). No serious bleb-related infections were encountered in our study.…”

“…Non-penetrating, bleb-free glaucoma procedures intend to efficaciously lower IOP without the risk of severe postoperative complications and the need for an intensive postoperative care as it becomes necessary after filtration surgery (Godfrey et al 2009;Francis et al 2011;Grieshaber 2012;Jampel et al 2012;Bettin & Di Matteo 2013;Wallin et al 2013;Yamamoto et al 2013). Canaloplasty is a relatively novel surgical method which aims at restoring the natural pathway of aqueous humour outflow via Schlemm's canal using circumferential viscodilation and a tension suture to permanently distend the trabecular meshwork without inducing a filtering bleb (Godfrey et al 2009;Harvey & Khaimi 2011;Grieshaber 2012;Klink et al 2012).…”

“…Trabeculectomy achieves an excellent IOP reduction, remains the most frequently performed glaucoma surgery and is still considered as the gold standard in the surgical treatment of patients with glaucoma since its first introduction by Cairns (1968). Severe adverse events and the need for an intensive postoperative treatment regimen have encouraged glaucoma surgeons to develop less invasive nonpenetrating procedures avoiding filtering blebs (Godfrey et al 2009;Francis et al 2011;Grieshaber 2012;Jampel et al 2012;Bettin & Di Matteo 2013;Wallin et al 2013;Yamamoto et al 2013). Canaloplasty is a non-filtering, bleb-free method combining viscocanalostomy with the placement of a 360°i ntracanalicular tension suture within Schlemm's canal, thus allowing aqueous humour outflow through the natural pathway (Godfrey et al 2009;Harvey & Khaimi 2011;Grieshaber 2012).…”

Three-Year Follow-Up of Trabeculectomy with 5-Fluorouracil

“…Late-onset bleb leaks occur more frequently in glaucoma-filtering surgery with adjunctive use of MMC than with 5-FU [33] . MMCaugmented blebs appear thinner and more avascular than 5-FU-augmented blebs [34] and therefore may be prone to leaks [35] . The occurrence of postoperative bleb leakage in our study (5%) lies within the range of the wide variation of the reported incidence of this complication [5,20,33] .…”

Endophthalmitis in the Tertiary Referral Center in Iran; Etiology and Causative Organisms

“…13 Likewise, a wide variation in incidence of bleb-associated endophthalmitis, from 0.17% to 13.2%, has been reported. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Considering these wide fluctuations in incidence rates of various types of endophthalmitis and the obvious difference among them, this study aimed to determine the prevalence of various types of endophthalmitis and the causative organism in Iran's Tertiary Referral Center.…”