The 5-year incidence of bleb-related infection and its risk factors after filtering surgeries with adjunctive mitomycin C: collaborative bleb-related infection incidence and treatment study 2.

Abstract

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.

• Authors: Tetsuya Yamamoto, Akira Sawada, Chihiro Mayama, Makoto Araie, Shinji Ohkubo, Kazuhisa Sugiyama, Yasuaki Kuwayama, Collaborative Bleb-Related Infection Incidence and Treatment Study Group
• Journal: Ophthalmology (Ophthalmology) Vol. 121 Issue 5 Pg. 1001-6 (May 2014) ISSN: 1549-4713 [Electronic] United States
• PMID: 24424248 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Chemical References

• Alkylating Agents
• Anti-Bacterial Agents
• Mitomycin

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Alkylating Agents (administration & dosage)
• Anti-Bacterial Agents (therapeutic use)
• Cohort Studies
• Combined Modality Therapy
• Eye Infections, Bacterial (drug therapy, epidemiology, microbiology)
• Female
• Glaucoma (classification, surgery)
• Humans
• Incidence
• Kaplan-Meier Estimate
• Lens Implantation, Intraocular
• Male
• Middle Aged
• Mitomycin (administration & dosage)
• Phacoemulsification
• Prognosis
• Prospective Studies
• Risk Factors
• Surgical Wound Infection (drug therapy, epidemiology, microbiology)
• Surgically-Created Structures
• Trabeculectomy
• Young Adult