title: Surveillance of late-onset bleb leak, blebitis and bleb-related endophthalmitis--a UK incidence study.
abstract: OBJECTIVE
  To determine the incidence of late-onset bleb leak (BL), blebitis (B) and bleb-related endophthalmitis (BRE) after trabeculectomy surgery, and report the management approaches employed by UK ophthalmologists.
  
  
  METHODS
  Prospective case ascertainment study reporting of incident cases fulfilling the study definitions of BL, B and BRE through the reporting mechanism provided by the British Ophthalmic Surveillance Unit (BOSU; United Kingdom) for the period July 2007 to August 2008 (13 months). Two questionnaires completed at initial reporting and 6 months later were used to collect clinical details related to presentation, early and late management and outcome.
  
  
  RESULTS
  Ninety-eight cases were reported to the British Ophthalmic Surveillance Unit during the study period. Seventy-one first questionnaires were returned (response rate 72.4%). Of these, 11 were erroneous/duplicated. Sixty second questionnaires were sent out, and of these 37 fully completed questionnaires were returned. Analysis was, therefore, based upon 60 initial and 37 follow-up questionnaires. Overall incidences were estimated for isolated bleb leak (0.22%), blebitis without bleb leak (0.1%), blebitis with bleb leak (0.11%), and BRE with or without bleb leak (0.17%). Visual outcome in the BL group was good; however, in the BRE group half the patients ended with visions of perception of light or worse. There was a great variance in the initial and late management of these conditions. Surgical intervention for bleb leak seemed to result in the best chance of leak closure.
  
  
  CONCLUSIONS
  These complications of trabeculectomy surgery are relatively low but potentially visually devastating. This study updates the knowledge of the incidence of these complications, and suggests that no consistent management approach to any of the reported conditions was practised. In view of the potentially catastrophic consequences of these complications, formal guidance as to best practice would be beneficial, and further research to establish this is required.
authors.affiliation: Department of Ophthalmology, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK. Amar.Alwitry@nhs.net
authors.forename: A
authors.initials: A
authors.lastname: Alwitry
authors.forename: A J
authors.initials: AJ
authors.lastname: King
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D005901:Glaucoma / Q000601:surgery; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D013529:Surgical Wound Dehiscence / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014129:Trabecular Meshwork / Q000473:pathology*; D014130:Trabeculectomy / Q000009:adverse effects*; D006113:United Kingdom / Q000453:epidemiology