Cumulative Incidence of Bleb-related Infections After Mitomycin C-augmented Filtration Surgery Over 10 Years in Japanese Glaucoma Patients.

Abstract

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: 2,097 eyes from 1,508 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. BRI 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-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 1,460 eyes with primary open-angle glaucoma developed BRI. Younger age at surgery was identified as a significant risk factor for BRI (hazard ratio: 0.970 per 1 year, P = 0.025).

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.