Complications following incisional glaucoma surgery, minimally invasive glaucoma surgery, and cycloablative procedures: a 13-year retrospective review.

Abstract

Purpose: To evaluate the incidence, clinical course, and treatment outcomes of glaucoma surgery-related infections at a tertiary academic center over a 13-year time period.

Methods: Patients presenting at Duke Eye Center between January 1, 2010, and November 11, 2023, who underwent glaucoma surgery, including trabeculectomy, glaucoma drainage device (GDD) placement, GDD revision surgery, trabeculectomy bleb revision surgery, minimally invasive glaucoma surgery (MIGS), Xen gel stent implantation, and cycloablative procedures, were identified using an electronic medical record clinical database search. Diagnosis of blebitis, bleb-associated endophthalmitis, and tube malposition or tube exposure were determined using International Classification of Disease (9th and 10th editions) codes.

Results: A total of 12,115 glaucoma surgeries (in 6,684 patients) were identified during the study period. GDD implantation comprised the majority of glaucoma surgeries (33%), followed by trabeculectomy (with and without Ex-PRESS mini glaucoma shunt) (25.7%), GDD revision (8.9%), trabeculectomy bleb revision (8.6%), and transscleral cyclophotocoagulation (5.9%). There were 488 MIGS with and without phacoemulsification (4%) and 76 Xen gel stent surgeries (0.6%). Endophthalmitis was diagnosed in 18 eyes (0.96%) that underwent trabeculectomy, 11 eyes that underwent GDD implantation (0.20%), and 1 eye that underwent Xen stent implantation. Blebitis was diagnosed in 7 eyes: 5 were related to trabeculectomy (0.27%), and 2 were related to GDD placement (0.05%). The incidence of GDD malposition or erosion was 10.2%. No cases of endophthalmitis were diagnosed in patients with MIGS.

Conclusions: In our study cohort, infectious complications associated with trabeculectomy and GDD implant surgery were low; there were no cases of endophthalmitis associated with MIGS. The rate of GDD complications due to tube malposition or erosion was 10.2%.