Blebitis after temporal approach MSICS and phacoemulsification performed post-trabeculectomy: incidence, management,...

Blebitis, a postoperative complication following trabeculectomy, poses significant challenges, particularly when cataract surgeries such as manual small incision cataract surgery (MSICS) or phacoemulsification are performed subsequently. This study aimed to assess the incidence, risk factors, management strategies, and outcomes of blebitis in patients undergoing these procedures after trabeculectomy at ECWA Eye Hospital in Nigeria, providing insights into optimizing postoperative care.

This retrospective study analyzed records of patients who underwent temporal approach MSICS or phacoemulsification following a prior trabeculectomy over a six-month period. Inclusion criteria were prior trabeculectomy, subsequent cataract surgery within the study period, attendance at all scheduled follow-ups, IOP less than 20 mmHg, and informed consent for data use. Exclusion criteria included incomplete pre- and postoperative records, prior ocular infections, significant systemic comorbidities, or unrelated surgical complications. Postoperative management included topical steroids, antibiotics, and intraocular pressure (IOP)-lowering agents as needed. Statistical analyses included paired t-tests, chi-square tests, ANOVA, and Kaplan-Meier survival analysis.

Of the 53 eyes analyzed, 12 (22.6%) developed blebitis, while 41 (77.4%) remained quiet postoperatively. Preoperative IOP in the blebitis group was significantly higher (20.3 ± 3.5 mmHg) compared to 17.8 ± 2.9 mmHg in the quiet blebs group. After treatment, IOP stabilized at 14.5 ± 2.7 mmHg in the blebitis group and 13.2 ± 2.1 mmHg in the quiet blebs group. Visual acuity outcomes also improved, with good visual acuity (> 6/12-6/5) achieved in 8.3% of blebitis cases versus 26.8% in the quiet blebs group. Blebitis resolution occurred progressively, with complete resolution by the two-month follow-up. Kaplan-Meier survival analysis (p = 0.04) confirmed the effectiveness of early intervention with topical steroids and antibiotics in preserving bleb integrity and preventing complications.

The study highlights the importance of tailored postoperative management in resolving blebitis and improving patient outcomes. Findings underscore the need for vigilant follow-up, early intervention, and adherence to management protocols.