BLEB-RELATED ENDOPHTHALMITIS AFTER TRABECULECTOMY WITH MITOMYCIN-C

Purpose: To determine whether filtering blebs resulting from adjunctiv e use of mitomycin C (MMC) leads to an increased risk of endophthalmit is. Methods: The authors retrospectively reviewed the records of 232 c onsecutive trabeculectomies performed at the W. K. Kellogg Eye Center with adjunctive use of MMC from May 1990 through June 1993. Data obtai ned from the records included patient age, sex, race, type of glaucoma , site of filtration surgery, concentration and duration of exposure t o MMC, presence of early or late bleb leakage, and the occurrence of e ndophthalmitis. Results: Three patients were lost to follow-up less th an 1 month after surgery. A total of 229 eyes of 192 patients (110 wom en and 82 men) were included in the study. Mean follow-up of patients remaining free of infection was 18.5 +/- 10.8 months (range, 1-44 mont hs). The overall incidence of bleb-related endophthalmitis was 2.6%. E ndophthalmitis developed in 8% of patients (4 of 50) in whom an inferi or approach was used and in 1.1% (2 of 179) in whom a superior approac h was used (P = 0.02, Fisher's exact test). The estimated odds ratio f or the development of endophthalmitis after trabeculectomy with adjunc tive MMC for inferior versus superior filtration sites was 7.7. Conclu sion: Short-term follow-up of trabeculectomies performed with adjuncti ve use of MMC demonstrates an overall incidence of endophthalmitis com parable to filtration procedures performed with 5-fluorouracil or with out antifibrotic agents. However, inferior trabeculectomy performed wi th adjunctive MMC carries a significantly increased risk of bleb-relat ed endophthalmitis compared with filters performed superiorly.