RECURRENT BLEB INFECTIONS

Aim-To report the patient characteristics, causative organisms, and cl inical outcomes in patients with recurrent bleb related ocular infecti ons. Methods-The medical records of all patients diagnosed with bleb r elated ocular infection at the New York Eye and Ear Infirmary over a 1 0 year period were reviewed. Recurrent bleb infection was defined as a t least two episodes of bleb purulence with or without associated intr aocular inflammation separated by a quiescent period of at least 3 mon ths. Results-Recurrent bleb infections developed in 12 eyes of 12 pati ents (10 men, two women) a mean of 16.3 (SD 17.9) months (range 3-51 m onths) after the initial infection. Two patients developed a third epi sode 3 and 20 months, respectively, after the second infection, yieldi ng a total of 14 recurrent infection episodes. Recurrent infection dev eloped after trabeculectomy in 11 eyes (adjunctive 5-fluorouracil, nin e eyes; mitomycin C, one eye; no antifibrosis agent, one eye) and foll owing cataract extraction with inadvertent bleb formation in one eye. Four (36.4%) of the filtered eyes had undergone trabeculectomy at the inferior limbus. The mean follow up time from filtering surgery to the first bleb related infection was 28 months for the nine patients trea ted with 5-fluorouracil and 14 months for the single patient treated w ith mitomycin C. 11 (78.6%) cases had a documented bleb leak in the 4 week period before or at the time of recurrent infection. Topical, pro phylactic antibiotics had been used in 7114 (50%) cases. The same orga nism was cultured from the initial and recurrent infections in 2/14 (1 4.3%) cases. Conclusion-Eyes that have been successfully treated for b leb related infection remain at risk for recurrent infection. No appar ent correlation exists between organisms responsible for the initial a nd recurrent infections. The increased rate of recurrent bleb related infection in patients receiving adjunctive 5-fluorouracil compared to mitomycin C may have been related to the longer follow up, of the 5-fl uorouracil eyes.