Bleb-related Ocular Infection in Children after Trabeculectomy with Mitomycin C

Objective: The purpose of the study is to report the clinical course of bleb-related ocular infection in children after trabeculectomy with adjunctive mitomycin C. Design: The study design was a retrospective review of all patients with a diagnosis of bleb-related ocular infection after trabeculectomy with adjunctive mitomycin C. Participants: Three children were identified in whom late postoperative bleb-related ocular infection developed. Intervention: Treatment consisted of vitreous biopsy with intravitreous antibiotic and corticosteroid injection and/or bleb culture with topical and intravenous antibiotic administration. Main Outcome Measures: Visual acuity and intraocular pressure were measured. Results: Bleb-related ocular infection developed an average of 16.7 ± 10.9 months after trabeculectomy (range, 4–23 months). The mean age at presentation was 7.0 ± 2.6 years (range, 4–10 years). Vitreous cultures were positive for staphylococci in two cases. A bleb culture from the third case also grew staphylococcus. All of the children recovered their initial vision after treatment of infection. However, one lost six lines of vision after a subsequent retinal detachment. Additional glaucoma surgery was required in one patient. Conclusions: Late bleb-related ocular infection may occur in children after trabeculectomy with mitomycin C and is characterized by abrupt onset, bleb infiltration, and rapid progression. Despite early preservation of vision after treatment of infection, significant late visual loss can occur.