Publishing date: February 2014

Author(s): Yamamoto T (1), Sawada A (2), Mayama C (3), Araie M (3), Ohkubo S (4), Sugiyama K4, Kuwayama Y (5); The Collaborative Bleb-Related Infection Incidence and Treatment Study Group.

1 Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan. Electronic address: mmc-gif@umin.net.
2 Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan.
3 Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
4 Department of Ophthalmology and Visual Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
5 Department of Ophthalmology, Osaka Koseinenkin Hospital, Osaka, Japan.

PURPOSE: To report the 5-year incidence of bleb-related infection after mitomycin C-augmented glaucoma filtering surgery and to investigate the risk factors for infections.

DESIGN: Prospective, observational cohort study.

PARTICIPANTS: A total of 1098 eyes of 1098 glaucoma patients who had undergone mitomycin C-augmented trabeculectomy or trabeculectomy combined with phacoemulsification and intraocular lens implantation performed at 34 clinical centers.

METHODS: Patients were followed up at 6-month intervals for 5 years, with special attention given to bleb-related infections. The follow-up data were analyzed via Kaplan-Meier survival analysis and the Cox proportional hazards model.

MAIN OUTCOME MEASURES: Incidence of bleb-related infection over 5 years and risk factors for infections.

RESULTS: Of the 1098 eyes, a bleb-related infection developed in 21 eyes. Kaplan-Meier survival analysis revealed that the incidence of bleb-related infection was 2.2±0.5% (cumulative incidence ± standard error) at the 5-year follow-up for all cases, whereas it was 7.9±3.1% and 1.7±0.4% for cases with and without a history of bleb leakage, respectively (P = 0.000, log-rank test). When only eyes with a well-functioning bleb were counted, it was 3.9±1.0%. No differences were found between the trabeculectomy cases and the combined surgery cases (P = 0.398, log-rank test) or between cases with a fornix-based flap and those with a limbal-based flap (P = 0.651, log-rank test). The Cox model revealed that a history of bleb leakage and younger age were risk factors for infections.

CONCLUSIONS: The 5-year cumulative incidence of bleb-related infection was 2.2±0.5% in eyes treated with mitomycin C-augmented trabeculectomy or trabeculectomy combined with phacoemulsification and intraocular lens implantation in our prospective, multicenter study. Bleb leakage and younger age were the main risk factors for infections.

Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Ophthalmology. 2014 Jan 11. pii: S0161-6420(13)01104-4. doi: 10.1016/j.ophtha.2013.11.025.

PMID: 24424248
http://www.ncbi.nlm.nih.gov/pubmed/24424248