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Glaucoma-filtering bleb infections

Mac, Ivan MD, MBA; Soltau, Joern B. MD

Current Opinion in Ophthalmology: April 2003 - Volume 14 - Issue 2 - p 91-94

Purpose of review To present a review of the current literature regarding the management of glaucoma-filtring bleb infections.

Recent findings With the increased use of intraoperative antifibrotic (eg, mitomycin and fluorouracil) as an adjunct to standard trabeculectomy, an increased incidence is seen of late-onset filtering bleb-related infections. These infections range from infections localized to the bleb (blebitis) to endophthalmitis. Risk factors for bleb-related infections include an inferior or nasally located bleb; presence of a high bleb or blepharitis; development of a late-onset bleb leak; use of antifibrotic agents; chronic antibiotic use; and performance of a trabeculectomy alone versus a combined procedure.

Summary The optimal treatment for bleb-related infections is evolving, but consensus is that a high degree of vigilance and aggressive treatment are key to minimizing the potentially blinding nature of this complication. It is important to note that those glaucoma procedures that provide the lowest intraocular pressure are often those that predispose to bleb-related infections.

Department of Ophthalmology and Visual Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA.

Correspondence to Joern B. Soltau, MD, Kentucky Lions Eye Center, 301 East Muhammad Ali Boulevard, Louisville, KY 40202, USA; e-mail:

© 2003 Lippincott Williams & Wilkins, Inc.