Purpose: To obtain useful information for the appropriate prevention and treatment of bleb-related infection following trabeculectomy with antiproliferatives.
Subjects and methods: Fifty nine eyes of 57 patients who developed bleb-related infection after trabeculectomy at the Department of Ophthalmology of Gifu University Hospital from January, 1985 to December, 2007 were observed for at least 30 days. We describe the characteristics of the clinical findings, risk factors, treatment, and prognosis related to the use of antiproliferatives and the stages.
Results: Bleb leak was considered a significant risk factor. It was highly likely that inferior quadrant trabeculectomy induced endophthalmitis. Bleb-related infection was also observed in patients under treatment with topical antibiotics. The large incidence of patients with blebitis observed recently, requires attention since it may be associated with a recurrence of bleb-related infection. There was an increase in the number of patients who complained of either pain or visual acuity loss and an increase in the bacterial detection ratio which was related to the severity of the disease stage. The prognosis of visual acuity was relatively better with blebitis, and the function of the blebs was also maintained. The period between the onset of subjective symptoms and visit to the eye clinic was shorter in patients with endophthalmitis than in those with other stages. The prognosis of both visual function and intraocular pressure was poor. Endophthalmitis was frequently encountered in the patients who had been treated with 5-fluorouracil.
Conclusions: It is important to repair any bleb leak immediately and to maintain the daily hygiene of the bleb. Long-term careful observation is also essential.