Here’s a startling fact: the risk of a severe eye infection called endophthalmitis lingers for years after glaucoma drainage surgery, long after most patients and doctors might assume the danger has passed. But here's where it gets controversial—while both primary glaucoma drainage procedures carry similar infection risks, one of them poses significantly higher dangers compared to a completely different eye surgery, sparking questions about long-term patient monitoring and surgical choices.
New research presented at the American Glaucoma Society (AGS) 2026 Annual Meeting reveals that patients who undergo glaucoma drainage procedures—specifically tube shunt surgery and trabeculectomy—face a persistent risk of endophthalmitis for at least five years post-operation. What’s more, the risk isn’t just consistent; it increases over time. For instance, the likelihood of developing endophthalmitis after tube shunt surgery more than doubles from 0.82% at one year to 1.87% at five years. And this is the part most people miss—this risk is three to five times higher than that of scleral buckle surgery, a procedure used to repair retinal detachment, which had infection rates of just 0.19% to 0.39% over the same period.
Qais Dihan, MD, an ophthalmology resident at the University of Arkansas Medical School, emphasizes the need for ongoing vigilance. “Endophthalmitis can strike years after surgery, so continuous monitoring is crucial,” he told Medscape Medical News. The study, one of the largest of its kind, analyzed data from 12,849 patients who underwent tube shunt surgery, 9,006 who had trabeculectomy, and 3,097 who received scleral buckle procedures. While both glaucoma surgeries involve creating a filtering bleb—a small blister-like structure on the eye’s surface to drain fluid—tube shunt surgery inserts a silicone tube, whereas trabeculectomy relies on a surgically created flap without any implanted device.
The demographics of the glaucoma surgery groups were comparable, but the scleral buckle group was notably younger (average age 45 vs. 63 and 68 for tube shunt and trabeculectomy, respectively), had a higher proportion of men (58.1% vs. 50%), and was less racially diverse. These differences highlight the importance of considering patient profiles when evaluating surgical risks.
Here’s where opinions might diverge: While the adjusted hazard ratios between the two glaucoma surgeries didn’t differ significantly, the comparison with scleral buckle surgery revealed a consistently higher risk of endophthalmitis at every measured time point—4.72 times higher at one year, 3.29 times at three years, and a staggering 5.43 times at five years. This raises the question: Are the benefits of tube shunt surgery worth the heightened long-term infection risk?
Mohamed Khodeiry, MD, MSc, a glaucoma specialist at the University of Louisville, praised the study’s large population and rigorous control of variables but called for further research into how endophthalmitis impacts visual outcomes. “The findings suggest that infection risk isn’t limited to the early postoperative period,” he noted. “Factors unique to tube shunt procedures likely play a larger role than the implanted hardware alone.”
For clinicians, the key takeaway is clear: endophthalmitis is a rare but serious complication that can emerge years after surgery. Patients must be counseled about this risk, and ophthalmologists should prioritize long-term surveillance. But what do you think? Is the medical community doing enough to address these long-term risks, or should surgical protocols be reevaluated? Share your thoughts in the comments below.
