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Endophthalmitis and severe blebitis following trabeculectomy. Epidemiology and risk factors; a single-centre retrospective study

Wallin, Orjan; Al-ahramy, Abdullah M.; Lundström, Mats LU and Montan, Per (2014) In Acta Ophthalmologica 92(5). p.426-431
Abstract
Purpose: To study the epidemiology and risk factors of early-and late-onset postoperative endophthalmitis (PE) and severe blebitis following trabeculectomy. Methods: Retrospective, single-centre, observational study with a case-control design in part. Patients sustaining PE and severe blebitis following trabeculectomy or a combined trabeculectomy with a cataract extraction procedure performed from 1990 through 2008 and diagnosed from 1990 through 2012 were recorded at St Erik Eye Hospital. Incidence data were calculated with help from the hospital records. Notes data of cases and of six randomly selected but procedure matched control patients for each case were compared. Results: The joint rate of infection was 0.46% or 34 incidents in... (More)
Purpose: To study the epidemiology and risk factors of early-and late-onset postoperative endophthalmitis (PE) and severe blebitis following trabeculectomy. Methods: Retrospective, single-centre, observational study with a case-control design in part. Patients sustaining PE and severe blebitis following trabeculectomy or a combined trabeculectomy with a cataract extraction procedure performed from 1990 through 2008 and diagnosed from 1990 through 2012 were recorded at St Erik Eye Hospital. Incidence data were calculated with help from the hospital records. Notes data of cases and of six randomly selected but procedure matched control patients for each case were compared. Results: The joint rate of infection was 0.46% or 34 incidents in 7402 procedures. The frequency of early (occurring <6 weeks after surgery) onset PE was 0.19%, late PE was 0.19% and severe blebitis was 0.08%. Dominating aetiologies were staphylococci and streptococci. Overall, the infection severely impaired the visual function. Combined cataract and fistulating operations were less prone to develop late infections, p = 0.04, but no other decisive factors were identified in the case-control study. Data collection for all trabeculectomy surgeries from 1998 and onward identified an increased rate for late infection with the use of mitomycin C (MMC), 8 in 1171 surgeries or 0.7%, versus no such use, 0 case of late PE in 2136 surgeries, p < 0.001. Conclusions: Postoperative endophthalmitis is a devastating complication after trabeculectomy. The use of MMC increases the risk for delayed infection. Early PE after trabeculectomy is clearly more common than PE after cataract surgery. Developing efficacious prophylactic antibiotic regimens to reduce early PE after penetrating filtering procedures should be a major priority in ophthalmic surgery. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
antibiotic prophylaxis, antimetabolite, blebitis, endophthalmitis, trabeculectomy
in
Acta Ophthalmologica
volume
92
issue
5
pages
426 - 431
publisher
Wiley-Blackwell
external identifiers
  • wos:000339482700029
  • scopus:84904747057
ISSN
1755-3768
DOI
10.1111/aos.12257
language
English
LU publication?
yes
id
6ec86715-308a-4e28-92c9-ff04412277ca (old id 4590578)
date added to LUP
2014-09-04 10:00:12
date last changed
2017-11-12 03:08:47
@article{6ec86715-308a-4e28-92c9-ff04412277ca,
  abstract     = {Purpose: To study the epidemiology and risk factors of early-and late-onset postoperative endophthalmitis (PE) and severe blebitis following trabeculectomy. Methods: Retrospective, single-centre, observational study with a case-control design in part. Patients sustaining PE and severe blebitis following trabeculectomy or a combined trabeculectomy with a cataract extraction procedure performed from 1990 through 2008 and diagnosed from 1990 through 2012 were recorded at St Erik Eye Hospital. Incidence data were calculated with help from the hospital records. Notes data of cases and of six randomly selected but procedure matched control patients for each case were compared. Results: The joint rate of infection was 0.46% or 34 incidents in 7402 procedures. The frequency of early (occurring &lt;6 weeks after surgery) onset PE was 0.19%, late PE was 0.19% and severe blebitis was 0.08%. Dominating aetiologies were staphylococci and streptococci. Overall, the infection severely impaired the visual function. Combined cataract and fistulating operations were less prone to develop late infections, p = 0.04, but no other decisive factors were identified in the case-control study. Data collection for all trabeculectomy surgeries from 1998 and onward identified an increased rate for late infection with the use of mitomycin C (MMC), 8 in 1171 surgeries or 0.7%, versus no such use, 0 case of late PE in 2136 surgeries, p &lt; 0.001. Conclusions: Postoperative endophthalmitis is a devastating complication after trabeculectomy. The use of MMC increases the risk for delayed infection. Early PE after trabeculectomy is clearly more common than PE after cataract surgery. Developing efficacious prophylactic antibiotic regimens to reduce early PE after penetrating filtering procedures should be a major priority in ophthalmic surgery.},
  author       = {Wallin, Orjan and Al-ahramy, Abdullah M. and Lundström, Mats and Montan, Per},
  issn         = {1755-3768},
  keyword      = {antibiotic prophylaxis,antimetabolite,blebitis,endophthalmitis,trabeculectomy},
  language     = {eng},
  number       = {5},
  pages        = {426--431},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Ophthalmologica},
  title        = {Endophthalmitis and severe blebitis following trabeculectomy. Epidemiology and risk factors; a single-centre retrospective study},
  url          = {http://dx.doi.org/10.1111/aos.12257},
  volume       = {92},
  year         = {2014},
}