Post-Operative Infections Following Glaucoma Drainage Surgery

Abstract

Glaucoma drainage surgery is performed commonly throughout the world for the surgical treatment of glaucoma. Typically, a guarded fistula is fashioned leading to a drainage bleb that represents subconjunctival collection and egress of aqueous humour from the eye. Bleb related infections (BRI) include blebitis and bleb related endophthalmitis (BRE). Although rare, BRI can be blinding, and appropriate vigilance is needed to ensure prompt diagnosis and treatment to save sight. Pre-operatively, blepharoconjunctivitis must be treated as well as any potential sources of infection. Clinicians must examine thoroughly to exclude bleb leaks and conjunctival erosions post-operatively. Patients must be educated about seeking care immediately if ocular redness, pain, discharge, or decreased vision develops. If BRI is diagnosed, sampling of ocular tissues is necessary for culture and sensitivity, followed by administration of broad-spectrum antibiotics. The interval from onset of symptoms to treatment, initial visual acuity, clarity of cornea at presentation, type of infecting organism, and presence or absence of diabetes mellitus are associated with final visual outcome particularly for BRE.