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Abstract #6933 Published in IGR 4-1
Incidence of late-onset bleb-related complications following trabeculectomy with mitomycin
DeBry PW; Perkins TW; Heatley G; Kaufman PK; Brumback LCArchives of Ophthalmology 2002; 120: 297-300
OBJECTIVES: To determine the incidence of late-onset bleb-related complications following trabeculectomy with mitomycin and to report the management and outcome of bleb leaks following trabeculectomy with mitomycin. METHODS: A retrospective medical record review of all patients who underwent trabeculectomy with mitomycin from June 1st, 1991, through April 30st, 1998, at the authors' institution was performed. The Kaplan-Meier survival method was used to estimate the probability of (1) endophthalmitis, (2) blebitis, (3) a bleb leak, and (4) the combined outcome (the first occurrence of a bleb leak, blebitis, or endophthalmitis). This survival analysis included only the first trabeculectomy in an eye, with at least three months of follow-up during the study period. A separate description of bleb leak management and outcome was performed. RESULTS: Two hundred and thirty-nine eyes of 198 patients were included in the survival analysis. The average follow-up was 2.7 (range, 0.3-7.3) years. Twenty eyes (8%) from 19 patients experienced a bleb leak; the adjusted incidence was 3.2% per patient-year. Five eyes (2%) had an episode of blebitis. Eight eyes (3%) experienced an episode of endophthalmitis; the follow-up adjusted incidence (number of events per patient-year) was 1.3%. Twenty-seven eyes (11%) from 26 patients had at least one of the complications of a bleb leak, blebitis, or endophthalmitis; the adjusted incidence was 4.4% per patient-year. A Kaplan-Meier analysis estimated the five-year probability of developing a bleb leak, blebitis, or endophthalmitis to be 17.9%, 6.3%, and 7.5%, respectively. Two hundred and fifty-eight trabeculectomies in 242 eyes of 198 patients were included in the description of bleb leak management and outcome. Bleb leaks occurred in 22 eyes (9% of the 258 trabeculectomies). Seventeen eyes were successfully treated with office-based measures, and four ultimately underwent surgical bleb revision. One eye without infection continued to leak after 11 months of office-based therapy. CONCLUSIONS: There is significant morbidity associated with a trabeculectomy with mitomycin. The incidence of a bleb leak or an infection continues at a fairly constant rate over time, such that at five years, up to 23% of all patients might develop one of these complications. An isolated bleb leak seems to be a relatively benign condition, as three quarters resolve with office-based methods.
Dr. P.W. DeBry, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, 2870 University Ave, Suite 206, Madison, WI 53705, USA
Classification:
12.8.11 Complications, endophthalmitis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
