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Abstract #15973 Published in IGR 2-3
Bleb related ocular infection: a feature of the HELP syndrome
Liebmann JM; Ritch RBritish Journal of Ophthalmology 2000; 84: 1338-1339
The introduction of 5-fluorouracil and mitomycine-C markedly improved the surgical success rates after filtering surgery. The thin, avascular, cavitated blebs produced particularly with MMC have lead to a resurgence of chronic hypotony, bleb leaks, bleb infections and endophthalmitis. Many of these patients complain of pain. The combination of hypotony, endophthalmitis, leak, pain has been called the HELP syndrome. This editorial comments amongst others on a paper by Lehmann that reported that late endophthalmitis is associated with bleb infection, diabetes mellitus and the use of anti-fibrosis agents. With anti-fibrosis agents endophthalmitis develops considerably earlier than without. Endophthalmitis leads to a significant loss of vision in a large proportion of eyes. The problem of endophthalmitis after anti-fibrotic agents is worldwide in scope. It involves all ethnic and racial groups and all ages. Bleb related infections can be a serious cause of permanent vision loss and may interfere with bleb function. The authors therefor wonder whether the wide-spread use of anti-fibrosis agents is justified. They end by citing the study of the Moorfields group on Transforming Growth Factor Beta. There is hope for anti-fibrosis with the same amount of pressure reduction but with less complications.
Dep of Ophthalmology, The New York Eye and Ear Infirmary, 310 East 14th Street, New York, NY 10003, USA. Email: ritch@inx.net
Classification:
12.8.11 Complications, endophthalmitis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
