Abstract
AIMS/BACKGROUND—The introduction of the adjunctive use of antiproliferatives to trabeculectomy has greatly improved the success rate of this operation. Trabeculectomy with antiproliferative treatment, however, is usually associated with a cystic and thin walled filtering bleb, which may be more susceptible to infection. The objective of this study was to evaluate the incidence, clinical findings, and risk factors of delayed onset, bleb related infection after trabeculectomy with adjunctive mitomycin C (MMC) or 5-fluorouracil (5-FU) treatment. METHODS—The records of 632 glaucoma patients who underwent 966 trabeculectomies, with and without the use of adjunctive MMC or 5-FU treatment, between January 1985 and February 1995 were analysed. The mean follow up period was 3.5 (2.4) years (range 0.1 to 11.2 years). The mean patient age was 54.8 (18.8) years (range 0 to 88 years). RESULTS—Bleb related infection occurred in one of 76 trabeculectomies that did not receive antiproliferatives (1.3%), three of 228 treated with 5-FU (1.3%) trabeculectomies, and seven of 662 treated with MMC (1.1%). Five eyes developed blebitis; six eyes developed endophthalmitis. Bleb related infection developed an average of 3.1 (1.6) (range 0.4 to 6.0) years after trabeculectomy. All eyes had avascular or hypovascular blebs that were cystic in shape before infection and all eyes had reduced intraocular pressure. Early wound leaks and chronic, intermittent bleb leaks were identified to be risk factors for the bleb related infection. CONCLUSION—The incidence of delayed onset, bleb related infection after trabeculectomy with antiproliferative treatment is similar to that after trabeculectomy without antiproliferatives.
Full Text
The Full Text of this article is available as a PDF (120.7 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Ashkenazi I., Melamed S., Avni I., Bartov E., Blumenthal M. Risk factors associated with late infection of filtering blebs and endophthalmitis. Ophthalmic Surg. 1991 Oct;22(10):570–574. [PubMed] [Google Scholar]
- Brown R. H., Yang L. H., Walker S. D., Lynch M. G., Martinez L. A., Wilson L. A. Treatment of bleb infection after glaucoma surgery. Arch Ophthalmol. 1994 Jan;112(1):57–61. doi: 10.1001/archopht.1994.01090130067019. [DOI] [PubMed] [Google Scholar]
- Cairns J. E. Trabeculectomy. Preliminary report of a new method. Am J Ophthalmol. 1968 Oct;66(4):673–679. [PubMed] [Google Scholar]
- Caronia R. M., Liebmann J. M., Friedman R., Cohen H., Ritch R. Trabeculectomy at the inferior limbus. Arch Ophthalmol. 1996 Apr;114(4):387–391. doi: 10.1001/archopht.1996.01100130383004. [DOI] [PubMed] [Google Scholar]
- Freedman J., Gupta M., Bunke A. Endophthalmitis after trabeculectomy. Arch Ophthalmol. 1978 Jun;96(6):1017–1018. doi: 10.1001/archopht.1978.03910050541009. [DOI] [PubMed] [Google Scholar]
- Greenfield D. S., Suñer I. J., Miller M. P., Kangas T. A., Palmberg P. F., Flynn H. W., Jr Endophthalmitis after filtering surgery with mitomycin. Arch Ophthalmol. 1996 Aug;114(8):943–949. doi: 10.1001/archopht.1996.01100140151007. [DOI] [PubMed] [Google Scholar]
- Higginbotham E. J., Stevens R. K., Musch D. C., Karp K. O., Lichter P. R., Bergstrom T. J., Skuta G. L. Bleb-related endophthalmitis after trabeculectomy with mitomycin C. Ophthalmology. 1996 Apr;103(4):650–656. doi: 10.1016/s0161-6420(96)30639-8. [DOI] [PubMed] [Google Scholar]
- Katz L. J., Cantor L. B., Spaeth G. L. Complications of surgery in glaucoma. Early and late bacterial endophthalmitis following glaucoma filtering surgery. Ophthalmology. 1985 Jul;92(7):959–963. doi: 10.1016/s0161-6420(85)33948-9. [DOI] [PubMed] [Google Scholar]
- Kitazawa Y., Kawase K., Matsushita H., Minobe M. Trabeculectomy with mitomycin. A comparative study with fluorouracil. Arch Ophthalmol. 1991 Dec;109(12):1693–1698. doi: 10.1001/archopht.1991.01080120077030. [DOI] [PubMed] [Google Scholar]
- Kitazawa Y., Suemori-Matsushita H., Yamamoto T., Kawase K. Low-dose and high-dose mitomycin trabeculectomy as an initial surgery in primary open-angle glaucoma. Ophthalmology. 1993 Nov;100(11):1624–1628. doi: 10.1016/s0161-6420(93)31426-0. [DOI] [PubMed] [Google Scholar]
- LEOPOLD I. H., APT L. Postoperative intraocular infections. Am J Ophthalmol. 1960 Dec;50:1225–1247. doi: 10.1016/0002-9394(60)91013-8. [DOI] [PubMed] [Google Scholar]
- Mandelbaum S., Forster R. K., Gelender H., Culbertson W. Late onset endophthalmitis associated with filtering blebs. Ophthalmology. 1985 Jul;92(7):964–972. doi: 10.1016/s0161-6420(85)33947-7. [DOI] [PubMed] [Google Scholar]
- Mermoud A., Salmon J. F., Murray A. D. Trabeculectomy with mitomycin C for refractory glaucoma in blacks. Am J Ophthalmol. 1993 Jul 15;116(1):72–78. doi: 10.1016/s0002-9394(14)71747-7. [DOI] [PubMed] [Google Scholar]
- Mills K. B. Trabeculectomy: a retrospective long-term follow-up of 444 cases. Br J Ophthalmol. 1981 Nov;65(11):790–795. doi: 10.1136/bjo.65.11.790. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Moutschen M. P., Scheen A. J., Lefebvre P. J. Impaired immune responses in diabetes mellitus: analysis of the factors and mechanisms involved. Relevance to the increased susceptibility of diabetic patients to specific infections. Diabete Metab. 1992 May-Jun;18(3):187–201. [PubMed] [Google Scholar]
- Palmer S. S. Mitomycin as adjunct chemotherapy with trabeculectomy. Ophthalmology. 1991 Mar;98(3):317–321. doi: 10.1016/s0161-6420(91)32293-0. [DOI] [PubMed] [Google Scholar]
- SUGAR H. S., ZEKMAN T. Late infection of filtering conjunctival scars. Am J Ophthalmol. 1958 Aug;46(2):155–170. doi: 10.1016/0002-9394(59)90003-0. [DOI] [PubMed] [Google Scholar]
- Shirato S., Kitazawa Y., Mishima S. A critical analysis of the trabeculectomy results by a prospective follow-up design. Jpn J Ophthalmol. 1982;26(4):468–480. [PubMed] [Google Scholar]
- Skuta G. L., Beeson C. C., Higginbotham E. J., Lichter P. R., Musch D. C., Bergstrom T. J., Klein T. B., Falck F. Y., Jr Intraoperative mitomycin versus postoperative 5-fluorouracil in high-risk glaucoma filtering surgery. Ophthalmology. 1992 Mar;99(3):438–444. doi: 10.1016/s0161-6420(92)31951-7. [DOI] [PubMed] [Google Scholar]
- Tabbara K. F. Late infections following filtering procedures. Ann Ophthalmol. 1976 Oct;8(10):1228–1231. [PubMed] [Google Scholar]
- Taniguchi T., Kitazawa Y., Shimizu U. Long-term results of 5-fluorouracil trabeculectomy for primary open-angle glaucoma. Int Ophthalmol. 1989 Jan;13(1-2):145–149. doi: 10.1007/BF02028655. [DOI] [PubMed] [Google Scholar]
- Ticho U., Ophir A. Late complications after glaucoma filtering surgery with adjunctive 5-fluorouracil. Am J Ophthalmol. 1993 Apr 15;115(4):506–510. doi: 10.1016/s0002-9394(14)74454-x. [DOI] [PubMed] [Google Scholar]
- Wolner B., Liebmann J. M., Sassani J. W., Ritch R., Speaker M., Marmor M. Late bleb-related endophthalmitis after trabeculectomy with adjunctive 5-fluorouracil. Ophthalmology. 1991 Jul;98(7):1053–1060. doi: 10.1016/s0161-6420(91)32177-8. [DOI] [PubMed] [Google Scholar]
- Yaldo M. K., Stamper R. L. Long-term effects of mitomycin on filtering blebs. Lack of fibrovascular proliferative response following severe inflammation. Arch Ophthalmol. 1993 Jun;111(6):824–826. doi: 10.1001/archopht.1993.01090060112033. [DOI] [PubMed] [Google Scholar]
- Yamashita H., Eguchi S., Yamamoto T., Shirato S., Kitazawa Y. Trabeculectomy: a prospective study of complications and results of long-term follow-up. Jpn J Ophthalmol. 1985;29(3):250–262. [PubMed] [Google Scholar]