Trabeculectomy-Related Complications in Olmsted County, Minnesota, 1985 Through 2010

Olayanju, Jessica A.; Hassan, Mohamed B.; Hodge, David O.; Khanna, Cheryl L.

doi:10.1001/jamaophthalmol.2015.57

Cited by 71 publications

(48 citation statements)

References 34 publications

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“…This predisposes to thin walled, avascular blebs which lead to frank bleb leaks and have a decreased capacity for healing, possibly related to a limited blood supply causing ischemia 6,26–29. Neither anti-fibrotic agent was found to confer a greater risk for BRI (Tables 2 and 3), which concurs with other studies 5,8,12,13. The duration of exposure to the anti-fibrotic agent was also not significant ( P =0.73).…”

Section: Discussionsupporting

confidence: 88%

“…The current premise is that blebitis precedes and leads to BRE if left untreated. While nearly all studies agree that diabetes, inferior bleb position, bleb leak and bleb manipulation are strong risk factors for BRI, dispute exists over others, such as age and gender 6,8,9,11–13. It is therefore pertinent that our study examines the risk factors in our population and their impact on the development of BRI.…”

Section: Introductionmentioning

confidence: 96%

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Bleb related infections: clinical characteristics, risk factors, and outcomes in an Asian population

Yap¹,

Chin²,

Ku³

et al. 2016

OPTH

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PurposeComparison of the demographic, ocular, systemic and microbiological characteristics of eyes with bleb related infection (BRI) and bleb related endophthalmitis (BRE).MethodsRetrospective chart review of patients with BRI from January 1996–July 2013. Identification done via the center’s longstanding endophthalmitis audit, BRI audit and laboratory database identifying all conjunctival swabs from blebs. Blebitis was defined as anterior segment inflammation with mucopurulent material in or around the bleb, with anterior chamber cells but no hypopyon. BRE was defined by the presence of hypopyon or vitreous inflammation.ResultsTwenty-nine patients with blebitis and 10 with BRE were identified. Mean age of subjects (n=39) was 68.4 (±13.3) with a preponderance of men (74.4%) and Chinese ethnicity (74.4%). BRE patients were 10.7 years older than blebitis patients (P=0.026). 28 (71.8%) subjects had primary open angle glaucoma. The presenting intraocular pressure (IOP) dropped in blebitis but almost doubled in BRE (P=0.011) compared to average preinfective IOP. Two weeks after treatment, IOPs in both groups returned to close to preinfective levels. Subjects with blebitis more often had an avascular bleb (88.0%) while those with BRE trended toward a moderately vascular bleb (50%). The distribution of causative microorganisms between the groups was similar.ConclusionOur study indicates that risk factors are similar in both groups even though the visual outcome and clinical course, in the form of IOP findings and bleb vascularity, can diverge significantly. The decreased IOP in blebitis subjects represents objective evidence of subclinical leaks or bleb sweating.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 96%

Bleb related infections: clinical characteristics, risk factors, and outcomes in an Asian population

Yap¹,

Chin²,

Ku³

et al. 2016

OPTH

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“…From previous literature, there were varying rates of short-term complications (from 2 weeks to 1 year after trabeculectomy) ranging from 5.2% to 50%. [456789] Our result is quite similar to the collaborative initial glaucoma treatment study (CIGTS)[5] which found early postoperative complications in 232 eyes (50%) during the first month after initial trabeculectomy even though most of the participants in the CIGTS were Caucasian or of African descent. Unlike our population, all the participants were never exposed to topical medications before trabeculectomy, and a limbus-based conjunctival flap technique without MMC use was used.…”

Section: Discussionsupporting

confidence: 83%

“…The previous studies reported various rates[456789] and types of complications after trabeculectomy. Risk factors which were relevant for the development of complications and surgical failure were also different among studies.…”

mentioning

confidence: 99%

Incidence of short-term complications and associated factors after primary trabeculectomy in Chiang Mai University Hospital

Leeungurasatien

Khunsongkiet

Pathanapitoon

et al. 2016

Indian J Ophthalmol

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Background:To determine the incidence of early postoperative complications and associated factors after primary trabeculectomy in Thai glaucoma patients.Design:This was a retrospective observational study performed in Chiang Mai University Hospital.Participants:One hundred and eighteen glaucoma patients participated in the study.Methods:All glaucoma patients underwent primary trabeculectomy with mitomycin C (MMC) using fornix-based conjunctival flap technique between December 2011 and May 2013. Surgical complications during the first 3 months of follow-up were recorded, and associated risk factors were analyzed.Main Outcome Measures:The incidence of posttrabeculectomy complications was the main outcome measure.Results:One hundred and eighteen eyes of 118 patients were included. Early postoperative complications developed in 55 eyes (56.7%). Complications included hypotony (25 eyes, 27.2%), serous choroidal detachment (CD) (14 eyes, 15.6%), subconjunctival hemorrhage (12 eyes, 13.0%), hyphema (11 eyes, 12.4%), bleb leak (8 eyes, 8.8%), encapsulated bleb (2 eyes, 2.2%), aqueous misdirection (1 eyes, 1.1%), corneal epithelial defect (1 eyes, 1.1%), and overfiltration (1 eyes, 1.1%). There were no reported cases of endophthalmitis or blebitis. Hypotony was associated with serous CD (P = 0.006), and hyphema was associated with neovascular glaucoma (NVG) patients (P = 0.009). NVG was not associated with the increased rate of surgical failure (P = 0.083).Conclusions:The incidence of early complications after first-time trabeculectomy with MMC was high (56.7%) in this Thai clinic setting, but most were transient and self-limited conditions. The correlations between hypotony and CD as well as hyphema and NVG were compatible with the previous studies.

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“…Hypotony was defined as a subject maintaining an IOP level of no greater than 5 mm Hg. The remaining list of complications included choroidal effusion, choroidal hemorrhage, hyphema, microhyphema, and aqueous misdirection [10]. …”

Section: Methodsmentioning

confidence: 99%

Bleb Needling with Mitomycin C as Adjunctive Therapy in Failing Blebs: A Retrospective Study

Noce

Vagge

Traverso³

2019

Ophthalmic Res

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Purpose: To evaluate the effects and complications related to use of mitomycin C (MMC) as an adjunctive therapy in bleb needling. Methods: Retrospective review of the records of patients affected by open-angle glaucoma who underwent a bleb revision as a treatment for failed trabeculectomy. All subjects underwent surgery with a fornix-based approach to incision. Full baseline data for each patient included a comprehensive ocular and medical history, the patient’s Snellen visual acuity test results, and Goldmann applanation tonometry test results. Data were reported following observations occurring at 6, 12, 18, 24, and 30 months. In addition, the number and timing of needling with or without MMC subconjunctival injections and any short- and long-term complications were observed. Results: We included 101 patients, 56 (55.4%) male and 45 (44.6%) female. The mean age was 69.81 ± 16.19 years (range 28–92). Statistically significant effects of needling and needling and MMC (p values <0.05) in the decrease in intraocular pressure were observed. Three (2.9%) patients presented hypotony at the last follow-up visit. No other complications were observed. Conclusions: Needling bleb revision augmented with the use of MMC appears to be a more useful tool in the management of failing bleb.

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Trabeculectomy-Related Complications in Olmsted County, Minnesota, 1985 Through 2010

Cited by 71 publications

References 34 publications

Bleb related infections: clinical characteristics, risk factors, and outcomes in an Asian population

Bleb related infections: clinical characteristics, risk factors, and outcomes in an Asian population

Incidence of short-term complications and associated factors after primary trabeculectomy in Chiang Mai University Hospital

Bleb Needling with Mitomycin C as Adjunctive Therapy in Failing Blebs: A Retrospective Study

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