Factors associated with recurrence of bleb-related infections

• Published in: Japanese journal of ophthalmology Vol. 66; no. 6; pp. 559 - 571
• Main Authors: Ozawa, Kenji, Inuzuka, Masayuki, Murata, Kazuhiro, Ishihara, Takuma, Mochizuki, Kiyofumi, Sakaguchi, Hirokazu
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01-11-2022; Springer Nature B.V
• Subjects: Anterior chamber; Antibiotics; Clinical Investigation; Eye; Female; Glaucoma - surgery; Hazards; Humans; Hyperemia; Intraocular Pressure; Leakage; Male; Medical records; Medicine; Medicine & Public Health; Ocular Hypotension - etiology; Ophthalmology; Patients; Postoperative Complications - etiology; Rank tests; Recurrent infection; Retrospective Studies; Risk analysis; Risk factors; Statistical models; Trabeculectomy - adverse effects; Recurrence of bleb-related infection; Hypotony; Bleb leakage; Prophylactic use of topical antibiotics; Bleb-related infection
• ISSN: 0021-5155; 1613-2246
• DOI: 10.1007/s10384-022-00937-w

Purpose
To identify the risk factors for a recurrence of a bleb-related infection (BRI).
Study design
Retrospective cohort study.
Methods
The medical records of all patients diagnosed with BRI at Gifu University Hospital between January 1989 and December 2020 were reviewed. The time when conjunctival hyperemia could not be detected and when the anterior chamber was quiet were defined as the resolution time of the BRI. The primary endpoint was a recurrence of a BRI. Kaplan-Meier estimation and the Cox proportional hazards model were used to determine the risk of a recurrence from the initial onset data of each eye. Bacteriological studies were performed to determine the pathogen causing the BRI.
Results
There were 108 eyes of 103 patients followed for at least 3 months after the initial BRI. A recurrent bleb infection developed in 21 (19.4%) eyes of 21 patients (13 men, 8 women). Log-rank test at the 10-year follow-up examination revealed that hypotony at the onset of the BRI (
P
=0.004), the prophylactic use of topical antibiotics at the onset of the BRI (
P
=0.046), and bleb leakage after the resolution of the BRI (
P
=0.021) were significantly associated with a BRI recurrence. Cox proportional hazards model showed that ocular hypotony at the onset of the BRI (unadjusted,
P
=0.007; adjusted for bleb leakage,
P
=0.015) and bleb leakage after the resolution of the BRI (unadjusted,
P
=0.027; adjusted for hypotony,
P
=0.024) were significantly associated with a BRI recurrence. Other factors were not significantly associated with the recurrence of a BRI.
Conclusion
We recommend close observations when a bleb leakage is detected after the BRI has resolved.