Impact of Topically Administered Steroids, Antibiotics, and Sodium Hyaluronate on Bleb-Related Infection Onset: The Japan Glaucoma Society Survey of Bleb-Related Infection Report 4.

Hideto Sagara,Tetsuju Sekiryu,Kimihiro Imaizumi,Tetsuya Yamamoto

doi:10.1155/2017/7062565

Hideto Sagara, Tetsuju Sekiryu + Show 2 more

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https://doi.org/10.1155/2017/7062565

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Abstract

Purpose To investigate the impact of topically administered ophthalmic medications on the onset and severity of bleb-related infections. Methods Data obtained from 104 eyes of 104 patients with bleb-related infections were analyzed. We assigned an infection stage to each eye (stage 1–4) and analyzed the onset severity. Results Steroids and antibiotics were routinely administered to 13 (12.5%) and 42 (40.4%) eyes, respectively. The median stage of steroid-administered eyes was 3 versus 1 for eyes without steroid administration (P = 0.012). The median duration from surgery to infection for the steroid-administered eyes was 2.0 years versus 5.8 years for eyes without steroid administration (P = 0.030). The median duration from surgery to infection for the antibiotic-administered eyes was 6.4 years versus 3.9 years for eyes without antibiotic administration (P = 0.025). Multiple logistic regression analysis revealed that infections were severe in the steroid-administered eyes (odds ratio: 4.57). No infections developed within 16 weeks postoperatively. No relationship was detected between sodium hyaluronate and the analyzed factors. Conclusions Topical steroid administration beyond the immediate postoperative period may affect severe and earlier onset bleb-related infections. Conversely, topical antibiotic administration may be effective in suppressing earlier onset bleb-related infections.

Highlights

Filtering surgery is the most well-known surgical procedure for glaucoma [1, 2], and antifibrotic agents, such as mitomycin C, 5-fluorouracil, and steroids, improve postoperative intraocular pressure control [3,4,5,6,7,8,9]
As a part of the Japan Glaucoma Society Survey of Bleb-related Infection (JGSSBI) [14, 24, 25], we investigated the impact of steroids, antibiotics, and sodium hyaluronate on bleb-related infections
We investigated the impact of eye drops and eye ointments containing steroids, antibiotics, or sodium hyaluronate that were administered prior to the bleb-related infection onset

Summary

Introduction

Filtering surgery is the most well-known surgical procedure for glaucoma [1, 2], and antifibrotic agents, such as mitomycin C, 5-fluorouracil, and steroids, improve postoperative intraocular pressure control [3,4,5,6,7,8,9]. Blebs often become thin-walled and vulnerable over time Thereafter, complications, such as hypotony, bleb leakage, and blebrelated infections, can occur [10,11,12,13]. Topical administration of a steroid may improve postoperative intraocular pressure control [6,7,8], but it suppresses immunity [18, 19]; it may exacerbate infection. Prophylactic antibiotic treatment may be effective in preventing infection, some reports suggest that continuous postoperative antibiotic use paradoxically increases blebrelated infection risk [20, 21]. It has been reported that sodium hyaluronate eye drop administration protects vulnerable blebs and prevents late-onset bleb leaks [23]. Topical sodium hyaluronate administration may be effective in preventing bleb-related infections

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