In trabeculectomy with mitomycin C (MMC), the preferred method to reduce endophthalmitis risk from hypotony-related bleb-related infection is:
- A Targeting a diffuse, posteriorly located bleb rather than an anterior thin-walled bleb ✓
- B Placing a tight scleral flap suture released later by laser suture lysis
- C Applying MMC under the conjunctival flap only, avoiding the scleral flap bed
- D Avoiding antimetabolites entirely and using collagen implants instead
Explanation
Bleb-related endophthalmitis is most commonly associated with thin-walled, avascular, anteriorly located (limbal) blebs — often called 'tenuous' blebs. These are prone to leakage and bacterial ingress. Targeting a diffusely elevated, posteriorly located bleb with good vascularity (characteristic of 'physiological blebs') reduces infection risk. The use of MMC inherently creates avascular blebs, but surgical technique — using larger sponge areas and more posterior placement — helps create a more posterior diffuse bleb rather than a loculated anterior one. Releasable sutures allow controlled IOP reduction to avoid early hypotony while achieving adequate filtration later.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.