The occurrence of fibrosis after a trabeculectomy can cause bleb failure in a patient with glaucoma. Mitomycin inhibits postoperative scarring but is associated with a number of complications. DeBry et al measured these problems over time.
Complications following the use of mitomycin:
(1) blebitis
(2) endophthalmitis
(3) bleb leak
The cumulative risk of bleb leak continues to increase with time. Blebitis and endophthalmitis tend to reach a plateau after 5 years.
cumulative risk for bleb leak in percent =
= (0.3143 * ((years)^2)) + (1.8 * (years)) - 0.1
Years After Surgery
Cumulative Risk of Endophthalmitis
1 to 5
(1.66 * (number of years since surgery)) - 0.94
5 to 7
7.5%
Years After Surgery
Cumulative Risk of Blebitis
0 to 2
< 0.6%
2 - 5
(0.65 * ((years)^2)) - (2.71 * (years)) + 3.51
5 to 7
6.3%
A patient who has had a trabeculectomy using mitomycin should be followed for complications. Bleb leak becomes the most significant problem over time, but the majority can be handled with simple interventions.
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