Cumulative Incidence of Bleb-Related Infections after Mitomycin C-Augmented Filtration Surgery over 10 Years in Japanese Patients with Glaucoma.

PURPOSE

This study investigated the incidence rates and risk factors for bleb-related infections (BRIs) following mitomycin C (MMC)-augmented filtration surgeries, including trabeculectomy and Ex-Press implantation, in Japanese patients with glaucoma.

DESIGN

Retrospective cohort study.

SUBJECTS

Two thousand ninety-seven eyes from 1508 patients who underwent MMC-augmented filtration surgery between 2008 and 2022.

METHODS

We reviewed and extracted the medical records of baseline characteristics, surgical details, and follow-up data. Patients were categorized by surgery type and glaucoma diagnosis. Bleb-related infection cases were categorized by severity and analyzed in terms of demographic and surgical variables. Kaplan-Meier survival analysis was used to estimate the BRI incidence rate, and a Cox proportional hazards model was used to identify influencing factors.

MAIN OUTCOME MEASURES

The cumulative incidence of BRI in all patients who underwent filtration surgery.

RESULTS

In total, 50 eyes with BRI (49 patients; mean age: 52.6 years; 21 eyes from females) were identified, yielding an overall incidence rate of 2.38%. Stage I to III infections were observed in 27, 15, and 8 eyes, respectively. The cumulative incidence of BRI increased over time, with estimated rates of 1.5 ± 0.3% (standard error) at 5 years, 3.8 ± 0.7% at 10 years, and 6.4 ± 1.4% at 14 years. Furthermore, 33 eyes out of 1460 eyes with primary open-angle glaucoma limited to primary surgeries developed BRI. Younger age at surgery was identified as a significant risk factor for BRI (hazard ratio: 0.969 per 1 year; P < 0.001).

CONCLUSIONS

This study is the first to show that the risk of BRI continues to increase 10 years after MMC-augmented filtration surgery. When considering filtration surgery, it is important to take into account the patient's age and inform them of the benefits of the procedure and the long-term risk of infection. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.