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Risk factors for late-onset infection following glaucoma filtration surgery
H D Jampel1, H A Quigley, L A Kerrigan-Baumrind
1Wilmer Eye Institute, Maumenee B-110, 600 N Wolfe St, Baltimore, MD 21287-9205, USA. hjampel@jhmi.edu
Objective:
To determine the risk factors for late-onset infection following glaucoma filtration surgery.
Methods:
We performed a case-control study comparing 131 cases of late-onset infection collected from 27 surgeons at 10 centers with 500 controls matched for date of surgery and surgeon. The criterion for the presence of infection was severe anterior chamber reaction occurring later than 4 weeks after surgery. An opaque bleb and positive culture results were not required for diagnosis. Risk factors were identified by univariate and multivariate logistic regression analyses.
Results:
Some of the risk factors that were statistically significant in the multivariate model after adjusting for age, race, and sex were (1) performance of a full-thickness rather than a guarded procedure (risk ratio [RR], 13.1; 95% confidence interval [CI], 2.12-80.9), (2) filtration surgery performed without concurrent cataract surgery (RR, 2.25; 95% CI, 1.24-4.08), (3) use of mitomycin (RR, 2.48; 95% CI, 1.06-5.83), (4) intermittent use of antibiotics after surgery (RR, 2.10; 95% CI, 1.09-4.02), and (5) continuous use of antibiotics after surgery (RR, 5.94; 95% CI, 2.09-16.9).
Conclusions:
Eyes undergoing full-thickness procedures or filtration surgery without cataract extraction are at increased risk for late infection. Intraoperative mitomycin and episodic or continuous antibiotic use after the postoperative period are associated with an increased risk of infection.
Insights
Glaucoma filtration surgery carries risks for late-onset infection. Full-thickness procedures, no concurrent cataract surgery, intraoperative mitomycin, and post-operative antibiotic use increase infection risk.
Area of Science:
- Ophthalmology
- Surgical Outcomes
- Infectious Disease
Background:
- Late-onset infections can complicate glaucoma filtration surgery.
- Identifying risk factors is crucial for preventing post-operative complications.
Purpose of the Study:
- To determine risk factors associated with late-onset infection after glaucoma filtration surgery.
Main Methods:
- A case-control study involving 131 infection cases and 500 controls.
- Infection defined as severe anterior chamber reaction >4 weeks post-surgery.
- Risk factors analyzed using logistic regression.
Main Results:
- Full-thickness procedures (RR 13.1) and surgery without cataract extraction (RR 2.25) increased risk.
- Intraoperative mitomycin (RR 2.48) and post-operative antibiotic use (RR 2.10-5.94) were significant risk factors.
Conclusions:
- Full-thickness glaucoma surgery and concurrent cataract surgery avoidance elevate late infection risk.
- Mitomycin use and prolonged antibiotic administration are linked to increased infection rates.