The problem of late bleb-related endophthalmitis is of great concern to glaucoma surgeons because of its increasing incidence related to the widespread use of adjunctive antifibrosis therapy. We therefore read with interest the article by Brown et al1 because of the important nature of the problem. Unfortunately, our prior publication2 on this topic must have eluded their literature search.
The conclusions of the article by Brown et al mirrored ours. In our 1991 article2 evaluating a series of 13 patients with late bleb-related endophthalmitis following trabeculectomy with fluorouracil, we reported a late infection rate of 3.0% for filtering surgery performed above the horizontal meridian and a rate of over 9.0% for surgery performed below the horizontal meridian. An intermittent positive Seidel test and thin-walled bleb were present in 62% of our cases presenting with an infection. All patients without vitreous involvement at the time of presentation had
Wolner B, Liebmann J, Ritch R, Speaker M, Marmor M, Sassani J. Treatment of Bleb Infection After Glaucoma Surgery. Arch Ophthalmol. 1994;112(10):1277-1278. doi:10.1001/archopht.1994.01090220027009