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Incidence of Late-Onset Bleb-Related Complications Following Trabeculectomy With Mitomycin
Peter W. DeBry, MD;
Todd W. Perkins, MD;
Gregg Heatley, MD;
Paul Kaufman, MD;
Lyndia C. Brumback, PhD
Arch Ophthalmol. 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 1, 1991, through April 30, 1998, at
our 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 3 months of follow-up during the study period. A
separate description of bleb leak management and outcome was performed.
Results Two hundred 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 1 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 5-year probability of developing a bleb leak, blebitis,
or endophthalmitis to be 17.9%, 6.3%, and 7.5%, respectively. Two hundred
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 4 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 5 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.
From the Departments of Ophthalmology and Visual Sciences (Drs DeBry,
Perkins, Heatley, and Kaufman), Statistics (Dr Brumback), and Biostatistics
and Medical Informatics (Dr Brumback), University of Wisconsin, Madison. Dr
DeBry is now with the Ophthalmology Department, Sabates Eye Center, Kansas
City, Mo, and Dr Brumback is now with the Division of Allergy and Infectious
Diseases, University of Washington School of Medicine, Seattle.
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