Br J Ophthalmol 1998;82:926-929 ( August )
Recurrent bleb infections
Samra Waheed,a
Jeffrey M Liebmann,a
David S Greenfield,a b
David C Ritterband,a
John A Seedor,a
Mahendra Shah,a
Robert Ritcha
a Department of
Ophthalmology, The New York Eye and Ear Infirmary, New York, USA, b Department of Neurology, New York Medical
College, Valhalla, New York, USA
Correspondence to: Robert Ritch, MD, Glaucoma Service, The New York Eye and Ear Infirmary,
310 East 14th Street, New York, NY 10003, USA.
Accepted for publication 4 March 1998
AIM To report the
patient characteristics, causative organisms, and clinical outcomes in
patients with recurrent bleb related ocular infections.
METHODSThe medical
records of all patients diagnosed with bleb related ocular infection at
the New York Eye and Ear Infirmary over a 10 year period were reviewed.
Recurrent bleb infection was defined as at least two episodes of bleb
purulence with or without associated intraocular inflammation separated
by a quiescent period of at least 3 months.
RESULTSRecurrent bleb
infections developed in 12 eyes of 12 patients (10 men, two women) a
mean of 16.3 (SD 17.9) months (range 3-51 months) after the initial
infection. Two patients developed a third episode 3 and 20 months,
respectively, after the second infection, yielding a total of 14 recurrent infection episodes. Recurrent infection developed after
trabeculectomy in 11 eyes (adjunctive 5-fluorouracil, nine eyes;
mitomycin C, one eye; no antifibrosis agent, one eye) and following
cataract extraction with inadvertent bleb formation in one eye. Four
(36.4%) of the filtered eyes had undergone trabeculectomy at the
inferior limbus. The mean follow up time from filtering surgery to the
first bleb related infection was 28 months for the nine patients
treated with 5-fluorouracil and 14 months for the single patient
treated with mitomycin C. 11 (78.6%) cases had a documented bleb leak in the 4 week period before or at the time of recurrent infection. Topical, prophylactic antibiotics had been used in 7/14 (50%) cases.
The same organism was cultured from the initial and recurrent infections in 2/14 (14.3%) cases.
CONCLUSIONEyes that
have been successfully treated for bleb related infection remain at
risk for recurrent infection. No apparent correlation exists between
organisms responsible for the initial and recurrent infections. The
increased rate of recurrent bleb related infection in patients
receiving adjunctive 5-fluorouracil compared to mitomycin C may have
been related to the longer follow up of the 5-fluorouracil eyes.
Keywords:
blebs;
ocular infections;
5-fluorouracil;
mitomycin C
© 1998 by British Journal of Ophthalmology
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