Trabeculectomy bleb-associated infections

Trabeculectomy with antimetabolites is the most commonly performed surgery worldwide for glaucoma patients with progressive optic nerve head injury and visual field loss despite maximum pharmacologic intraocular pressure–lowering therapy. Trabeculectomy bleb-associated infections remain one of the most feared early and long-term complications of trabeculectomy surgery because of their poor prognosis and variable response to antimicrobial therapy. Several studies have evaluated how surgical technique, conjunctival incision location, comorbid ocular pathology, concurrent medication use, and bleb morphology affect the risk of bleb-associated infection. New surgical techniques and devices aim to achieve a similar intraocular pressure reduction profile to trabeculectomy while avoiding the presence of a conjunctival bleb. We provide a comprehensive review of studies evaluating risk factors for bleb-associated infection after trabeculectomy and propose a diagnostic and therapeutic approach to bleb-associated infection.