Incidence of bleb-associated endophthalmitis in the United States

Kamyar Vaziri,1 Krishna Kishor,1 Stephen G Schwartz,1 Arindel S Maharaj,1 Darius M Moshfeghi,2 Andrew A Moshfeghi,3 Harry W Flynn Jr1 1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL, USA; 2Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA; 3USC Eye Institute, Department of Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA Purpose: To evaluate the 5-year incidence rate of blebitis and bleb-associated endophthalmitis in the United States. Methods: In this retrospective cross-sectional study, we utilized a large commercial health insurance claim-based database during 2007–2011 and identified all patients who had a record of trabeculectomy in 2007. These patients were followed until the end of 2011. During the follow-up period, all incidences of blebitis, confirmed bleb-associated endophthalmitis, and presumed bleb-associated endophthalmitis were recorded. Kaplan–Meier survival analysis was utilized to calculate 5-year cumulative incidence rates of blebitis and bleb-associated endophthalmitis following trabeculectomy procedures. Results: Among the 1,461 trabeculectomies included in our analysis, eight cases of blebitis, five cases of confirmed bleb-associated endophthalmitis, and eight cases of presumed bleb-associated endophthalmitis were identified. We found that the 5-year cumulative incidence of blebitis was 0.55%±0.19%. The 5-year cumulative incidence of bleb-associated endophthalmitis was 0.45%±0.2% when only confirmed cases were included and 1.3%±0.34% when presumed cases were also added to the analysis. The mean time from procedure to diagnosis was 45 months for blebitis and 33 months for bleb-associated endophthalmitis. Conclusion: Blebitis and bleb-related endophthalmitis are uncommon in the United States. The 5-year cumulative incidence was 0.55% for blebitis and 0.45%–1.3% for bleb-associated endophthalmitis. Keywords: bleb, blebitis, bleb-associated endophthalmitis, trabeculectom

Incidence of postoperative suprachoroidal hemorrhage after glaucoma filtration surgeries in the United States

Kamyar Vaziri,1 Stephen G Schwartz,1 Krishna S Kishor,1 Jorge A Fortun,1 Darius M Moshfeghi,2 Andrew A Moshfeghi,3 Harry W Flynn Jr1 1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; 2Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA; 3Department of Ophthalmology, USC Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, CA, USA Purpose: To report the 3-month incidence rates of postoperative suprachoroidal hemorrhage after glaucoma filtration surgeries and to examine the subsequent surgical treatments in these eyes.Methods: This is a retrospective study using the nationally pooled, insurance claim-based MarketScan databases from the years 2007–2011. Patients with records of trabeculectomy and/or tube shunt procedures were identified, and all cases of “definite” (ie, properly coded) and “suspected” (possibly miscoded) postoperative suprachoroidal hemorrhage occurring within 3 months of their glaucoma filtration procedures were captured along with the surgical interventions used for this condition. Kaplan–Meier survival analysis was used to evaluate the 3-month incidence rates of suprachoroidal hemorrhage, and regression analysis was applied to calculate the odds ratios, confidence intervals, and P-values.Results: There were 17,843 trabeculectomies and 9,597 tube shunt surgeries identified. Among these, there were 107 cases (247 including “suspected” cases) of postoperative suprachoroidal hemorrhage within 3 months of trabeculectomy and 113 cases (255 including “suspected” cases) within 3 months of tube shunt procedures. The 3-month cumulative incidence rate of postoperative suprachoroidal hemorrhage ranged from 0.6%±0.06% to 1.4%±0.09% after trabeculectomy and 1.2%±0.11% to 2.7%±0.16% after tube shunt surgery. Postoperative suprachoroidal hemorrhage was almost twice as likely to occur after tube shunt surgeries than after trabeculectomies for both “definite” and “definite” plus “suspected” cases (odds ratio, 1.98; 95% confidence interval, 1.51–2.58; P<0.001; and odds ratio, 1.95; 95% confidence interval, 1.63–2.32; P<0.001, respectively). Among the 502 “definite” and “suspected” cases of postoperative suprachoroidal hemorrhage, 32.9% (165 cases) had a treatment record of choroidal tap and 8.8% (44 cases) had a treatment record of pars plana vitrectomy.Conclusion: In this sample, the 3-month cumulative incidence rate of postoperative suprachoroidal hemorrhage was 0.6%–1.4% after trabeculectomy and 1.2%–2.7% after tube shunt procedures, and the majority of the cases appeared to be managed without further surgery. Postoperative suprachoroidal hemorrhage was almost twice as likely to occur after tube shunt surgeries as after trabeculectomies. Keywords: suprachoroidal hemorrhage, choroidal effusion, trabeculectomy, tube shunt, choroidal tap, pars plana vitrectom