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Surgery & Complications
Glaucoma filtering bleb infection demonstrating milky-appearing ischemic bleb surrounded by intense conjunctival hyperemia.

  • 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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