title: The 5-year incidence of bleb-related infection and its risk factors after filtering surgeries with adjunctive mitomycin C: collaborative bleb-related infection incidence and treatment study 2.
abstract: OBJECTIVE
  To report the 5-year incidence of bleb-related infection after mitomycin C-augmented glaucoma filtering surgery and to investigate the risk factors for infections.
  
  
  METHODS
  Prospective, observational cohort study.
  
  
  METHODS
  A total of 1098 eyes of 1098 glaucoma patients who had undergone mitomycin C-augmented trabeculectomy or trabeculectomy combined with phacoemulsification and intraocular lens implantation performed at 34 clinical centers.
  
  
  METHODS
  Patients were followed up at 6-month intervals for 5 years, with special attention given to bleb-related infections. The follow-up data were analyzed via Kaplan-Meier survival analysis and the Cox proportional hazards model.
  
  
  METHODS
  Incidence of bleb-related infection over 5 years and risk factors for infections.
  
  
  RESULTS
  Of the 1098 eyes, a bleb-related infection developed in 21 eyes. Kaplan-Meier survival analysis revealed that the incidence of bleb-related infection was 2.2±0.5% (cumulative incidence ± standard error) at the 5-year follow-up for all cases, whereas it was 7.9±3.1% and 1.7±0.4% for cases with and without a history of bleb leakage, respectively (P = 0.000, log-rank test). When only eyes with a well-functioning bleb were counted, it was 3.9±1.0%. No differences were found between the trabeculectomy cases and the combined surgery cases (P = 0.398, log-rank test) or between cases with a fornix-based flap and those with a limbal-based flap (P = 0.651, log-rank test). The Cox model revealed that a history of bleb leakage and younger age were risk factors for infections.
  
  
  CONCLUSIONS
  The 5-year cumulative incidence of bleb-related infection was 2.2±0.5% in eyes treated with mitomycin C-augmented trabeculectomy or trabeculectomy combined with phacoemulsification and intraocular lens implantation in our prospective, multicenter study. Bleb leakage and younger age were the main risk factors for infections.
authors.affiliation: Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan. Electronic address: mmc-gif@umin.net.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Sawada
authors.affiliation: Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors.forename: Chihiro
authors.initials: C
authors.lastname: Mayama
authors.affiliation: Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Araie
authors.affiliation: Department of Ophthalmology and Visual Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Ohkubo
authors.affiliation: Department of Ophthalmology and Visual Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Sugiyama
authors.affiliation: Department of Ophthalmology, Osaka Koseinenkin Hospital, Osaka, Japan.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Kuwayama
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000477:Alkylating Agents / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003131:Combined Modality Therapy; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005901:Glaucoma / Q000145:classification / Q000601:surgery*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D018918:Phacoemulsification; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D019738:Surgically-Created Structures; D014130:Trabeculectomy; D055815:Young Adult
chemical_list: D000477:Alkylating Agents; D000900:Anti-Bacterial Agents; D016685:Mitomycin