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Risk factors for bleb-related infection following trabeculectomy surgery: ocular surface findings—a case–control study
  1. Poornima A Rai1,
  2. Keith Barton1,2,
  3. Ian E Murdoch2
  1. 1NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, London, UK
  2. 2Department of Genetics, UCL Institute of Ophthalmology, London, UK
  1. Correspondence to Poornima A Rai, Moorfields Eye Hospital, 162 City Road, London EC1V2PD, UK; Poornima.rai{at}


Purpose Bleb-related infection (BRI) is a devastating complication of trabeculectomy surgery. The aim of this study was to identify ocular risk factors for BRI with specific emphasis on ocular surface parameters. It has been suggested that the frequency has increased since the introduction of antimetabolites, particularly mitomycin C.

Design A case–control study.

Method A clinical study of BRI following trabeculectomy surgery to investigate risk factors by documenting historical data review from patients records, self-reported questionnaire specific to ocular surface symptoms and a repeat detailed clinical examination of the lid, ocular surface and tear film.

Results Twenty-eight cases and 31 controls were assessed. The overwhelming risk factor for development of BRI was chronic blepharitis (multivariate analysis OR 16.3 (1.687 to 157.44) p=0.016). No increased risk was identified with the antimetabolite used during trabeculectomy surgery (p=0.38) or the type of conjunctival reflection adopted for surgery (p=0.38). Neither age (p=0.32) nor dry eyes (p=0.13) were identified as risk factors.

Conclusion An increased risk of BRI was identified in eyes with chronic blepharitis. To minimise the risk of infection following trabeculectomy surgery, it may be advisable to manage the lid disease in these patients prior to performing trabeculectomy surgery or offer an alternative treatment such as a shunt.

Trial registration number RAIQ1001.

  • Glaucoma
  • Treatment Surgery
  • Infection

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  • Contributors As per ICMJE guidelines, all the authors agree to be accountable for all aspects of the work done on this study. In addition, each individual author's contributions are the following: PAR: study design, validation, recruitment of study patients, clinical examination, data collection, data analysis, manuscript preparation and manuscript approval. KB: study design, interpretation of the data, manuscript preparation and manuscript approval. IEM: study design, validation, data analysis, statistics, manuscript preparation and manuscript approval.

  • Funding This study was funded by Friends of Moorfields. Special trustees of Moorfields (RAIQ1001).

  • Competing interests KB:Lecture honoraria: Allergan, Pfizer. Advisory boards: Glaukos, Alcon, Merck, Kowa, Amakem, Thea, Alimera, Refocus, Ivantis. Consultancy: Alcon, Aquesys, Ivantis, Refocus, Carl Zeiss Meditec, Kowa, Santen. Educational grants/research funding: AMO, New World Medical, Alcon, Merck, Allergan, Refocus. Stock: AqueSys, Ophthalmic Implants (PTE), Vision Futures (UK) (Director), London Claremont Clinic (Director), Vision Medical Events (Director). Patents: Ophthalmic Implants (PTE)—patent application only.

  • Competing interests None.

  • Ethics approval Local Research Ethics Committee at Moorfields Eye Hosital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data from the study belong to the Moorfields Eye Hospital and will be available by contacting the authors.

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