Br J Ophthalmol 1997;81:877-883 ( October )
Incidence of delayed onset infection after trabeculectomy with
adjunctive mitomycin C or 5-fluorouracil treatment
Kiyofumi Mochizuki,
Shuichi Jikihara,
Yuko Ando,
Nobuhide Hori,
Tetsuya Yamamoto,
Yoshiaki Kitazawa
Department of Ophthalmology, Gifu University School of
Medicine, Gifu-shi, Japan
Correspondence to: Kiyofumi Mochizuki, MD,
Department of Ophthalmology, Gifu University School of Medicine, 40 Tsukasa-machi, Gifu-shi 500, Japan.
Accepted for publication 4 June 1997
AIMS/BACKGROUND The introduction of the adjunctive
use of antiproliferatives to trabeculectomy has greatly improved the
success rate of this operation. Trabeculectomy with antiproliferative
treatment, however, is usually associated with a cystic and thin walled
filtering bleb, which may be more susceptible to infection. The
objective of this study was to evaluate the incidence, clinical
findings, and risk factors of delayed onset, bleb related infection
after trabeculectomy with adjunctive mitomycin C (MMC) or
5-fluorouracil (5-FU) treatment.
METHODSThe records of 632 glaucoma patients who
underwent 966 trabeculectomies, with and without the use of adjunctive
MMC or 5-FU treatment, between January 1985 and February 1995 were
analysed. The mean follow up period was 3.5 (2.4) years (range 0.1 to
11.2 years). The mean patient age was 54.8 (18.8) years (range 0 to 88 years).
RESULTSBleb related infection occurred in one of
76 trabeculectomies that did not receive antiproliferatives (1.3%),
three of 228 treated with 5-FU (1.3%) trabeculectomies, and seven of
662 treated with MMC (1.1%). Five eyes developed blebitis; six eyes
developed endophthalmitis. Bleb related infection developed an average
of 3.1 (1.6) (range 0.4 to 6.0) years after trabeculectomy. All eyes had avascular or hypovascular blebs that were cystic in shape before
infection and all eyes had reduced intraocular pressure. Early wound
leaks and chronic, intermittent bleb leaks were identified to be risk
factors for the bleb related infection.
CONCLUSIONThe incidence of delayed onset,
bleb related infection after trabeculectomy with antiproliferative
treatment is similar to that after trabeculectomy without antiproliferatives.
© 1997 by British Journal of Ophthalmology
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