- An uncommon but significant early- to late-onset complication of
glaucoma filtering surgery.
- Risk factors:
- Full thickness filtering surgery
- Use of antifibrotic agents such as 5-fluorouracil (5-FU) and
mitomycin-C (MMC)
- Late-onset filtering bleb leakage
- Inferior location of the filtering bleb
- Blepharitis or ocular surface disease
- Clinical features:
- Symptoms: pain and/or red eye (either sudden or sub-acute),
decreased vision, ocular irritation, light sensitivity
- Signs:
- Milky-appearing ischemic bleb surrounded by intense conjunctival
hyperemia
- Anterior chamber inflammatory reaction
- Mucopurulent infiltrate within the bleb
- Mild to moderate anterior segment inflammation
- Hypotony if associated with bleb leakage
- May be complicated with full-blown endophthalmitis
- Management:
- Workup:
- Culture bleb with conjunctival swab (and anterior chamber
tap for more severe infection)
- B-scan ultrasound to rule out posterior segment involvement
- Mild to moderate infection:
- Intensive topical antibiotics
- Topical steroids when appropriate
- Cycloplegics if indicated
- Frequent follow-up (often daily)
- Severe infection
- Hospitalization
- Intravenous antibiotic therapy
- Hourly topical fortified antibiotics
- Cycloplegicss
- Topical or intravitreal steroids
- Vitrectomy in cases of worsening despite aggressive therapy
- Visual prognosis is good with prompt and aggressive therapy
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