April 08, 2014
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Prevention, treatment of bleb-related infection crucial in trabeculectomy

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TOKYO — Prophylaxis of infection through bleb hygiene after surgery and treatment of bleb leakage are crucial to the success of trabeculectomy, according to one surgeon.

The Collaborative Bleb-related Infections Incidence and Treatment Study and the Japan Glaucoma Society Survey of Bleb-related Infection found vision-threatening complications such as bleb infection in 2% of trabeculectomy cases at 5 years and a 1% rate of endophthalmitis, Tetsuya Yamamoto, MD, said at the World Ophthalmology Congress

"In such cases, visual prognosis is very poor, particularly if the treatment of endophthalmitis is delayed. Around 30% to 40% of cases end up with less than 20/200 vision,” he said.

Tetsuya Yamamoto

However, trabeculectomy is still the gold standard for most glaucoma cases needing surgery. Long-term studies found that the visual field can be maintained for 10 to 20 years.

“Long-term prognosis is very good in terms of IOP control, with 80% to 90% of success cases achieving and maintaining adequately controlled pressure,” he said.

Progression of visual field loss may occur in some cases despite pressure control, with IOP around 10 mm Hg to 15 mm Hg. In such cases, trabeculectomy should be performed a second time, aiming at a lower IOP around 7 mm Hg to 8 mm Hg.

“Central visual field can usually be maintained in these conditions, with no need for medications, provided that bleb-related infection is prevented,” Yamamoto said.

Disclosure: Yamamoto receives consulting fees or board membership fees from Kowa, MSD, Otsuka Pharmaceutical, Senju Pharmaceutical, Santen PharmaceuticalAlcon Japan and Pfizer Japan.