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Bleb-related infection after primary trabeculectomy: medical chart reviews from 1993 to 2021
  1. Hsin-Yu Yang1,2,3,
  2. Sheng-Chu Chi2,
  3. Yu-Chieh Ko2,
  4. Mei-Ju Chen2,3,
  5. Tung-Mei Kuang2,3,4,
  6. Yu-Fan Chang2,3,
  7. Catherine Jui-Ling Liu2,3
  1. 1 Yuanshan and Suao Branch, Taipei Veterans General Hospital, Yilan, Taiwan
  2. 2 Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
  3. 3 School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
  4. 4 Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
  1. Correspondence to Dr Catherine Jui-Ling Liu, Department of ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan; jlliu{at}


Background To investigate the incidence of and risk factors for bleb-related infection (BRI) in patients who underwent mitomycin C-augmented primary trabeculectomy.

Methods We reviewed the medical charts of consecutive patients who had received primary trabeculectomy in Taipei Veterans General Hospital. We recorded the demographic and clinical characteristics of patients before, during and after surgery. Furthermore, we recorded the time interval between surgery and infection onset, clinical manifestations and visual outcomes of patients with BRI. The cumulative incidence of BRI was estimated using the Kaplan-Meier method. A Cox proportional hazards model was used to explore factors associated with BRI.

Results In total, 1663 eyes were postoperatively followed up for 94.57±65.23 months. The cumulative incidence of BRI was 1.86 per 1000 person-years during the 28-year follow-up period: 24 (1.44%) patients developed BRI and 6 (0.36%) patients additionally developed endophthalmitis. A multivariate analysis revealed a significant association of BRI with wound manipulation, high myopia and hyperlipidaemia. Patients younger than 60 years were more likely to receive wound manipulation than their elderly counterparts (<0.001). One year after BRI, the best corrected visual acuity of the eyes with blebitis did not change significantly, whereas that of the eyes with endophthalmitis worsened significantly.

Conclusion Risk factors for BRI after trabeculectomy include wound manipulation, high myopia and hyperlipidaemia. Considering myopia is highly prevalent throughout the world and is a risk factor for glaucoma, the lifelong risk of BRI after trabeculectomy in eyes with high myopia warrants the attention of ophthalmologists.

  • Glaucoma
  • Infection
  • Wound healing

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors H-YY and CJ-LL: conception and design of the work, acquisition of the data, analysis of the data, writing of the manuscript and revising the work. S-CC, Y-CK, M-JC, T-MK and Y-FC: acquisition of the data.Y-CK: revising the work. H-YY and CJ-LL are the guarantors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

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