High myopes and those with hyperlipidemia may be at greater risk for bleb-related infection after trabeculectomy, study finds. Photo: Justin Schweitzer, OD. Click image to enlarge.

Trabeculectomy is an effective approach for lowering IOP in glaucomatous eyes; however, patients who undergo this procedure have a lifelong risk of developing bleb-related infection (BRI), which can lead to endophthalmitis. Researchers recently investigated BRI risk factors after trabeculectomy and reported associations with high myopia, hyperlipidemia and wound manipulation.

The researchers conducted a retrospective 28-year cohort study to review the medical charts of patients (1,663 eyes) who received primary trabeculectomy with mitomycin-C at a single center. They reported the cumulative incidence of BRI to be 1.86 per 1,000 person-years during the follow-up period, with 1.44% of patients developing BRI and 0.36% of patients also developing endophthalmitis.

Multivariate analysis showed a significant association between BRI and wound manipulation, high myopia and hyperlipidemia. The researchers noted in their study that patients younger than 60 years of age were significantly more likely to receive wound manipulation than elderly patients. They also noted that the BCVA of eyes with blebitis didn’t change significantly at one year post-op, while eyes with endophthalmitis worsened significantly.

“Prudent use of antimetabolites in trabeculectomy may help minimize the BRI event,” the researchers concluded in their paper for the British Journal of Ophthalmology. “Patients with a history of trabeculectomy should be reminded to well control their dyslipidemia, and ophthalmologists should remain alert to a thin bleb in eyes with high myopia.”

Yang H, Chi S, Ko Y, et al. Bleb-related infection after primary trabeculectomy: medical chart reviews from 1993 to 2021. Br J Ophthalmol. October 25, 2022. [Epub ahead of print].