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Japanese Journal of Ophthalmology
Published in: Japanese Journal of Ophthalmology 4/2016

01-07-2016 | Clinical Investigation

Persistent hypotony after trabeculectomy: incidence and associated factors in the Collaborative Bleb-Related Infection Incidence and Treatment Study

Authors: Tomomi Higashide, Shinji Ohkubo, Yosuke Sugimoto, Yoshiaki Kiuchi, Kazuhisa Sugiyama

Published in: Japanese Journal of Ophthalmology | Issue 4/2016

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Abstract

Purpose

To investigate the incidence of and factors associated with persistent hypotony after trabeculectomy with mitomycin C in the Collaborative Bleb-Related Infection Incidence and Treatment Study (CBIITS), a 5-year prospective multicenter study.

Methods

A total of 955 eyes of 955 patients who underwent trabeculectomy with mitomycin C were studied. Surgical failure was defined as insufficient intraocular pressure (IOP) reduction (IOP > 21 mmHg or <20 % IOP reduction, or further glaucoma surgeries), loss of light perception, or persistent hypotony (IOP ≤ 5 mmHg persisting for >6 months). Factors associated with persistent hypotony in eyes with sufficient IOP reduction were determined by survival analysis and logistic regression analysis.

Results

The cumulative probabilities of surgical success and persistent hypotony at 5 years were 62.0 ± 1.7 % (±standard error) and 7.7 ± 0.9 %, respectively. In 685 eyes with sufficient IOP reduction, preoperative IOP (mmHg), limbus-based conjunctival flap, or choroidal detachment that occurred within 6 months of the surgery were significant risk factors for persistent hypotony [Cox proportional hazards regression model: hazard ratio, 0.95, 2.27, 3.24; 95 % confidence interval (CI), 0.91–0.98, 1.21–4.23, 1.51–6.95; P = 0.005, 0.01, 0.003, respectively]. Bleb infection and final visual acuity (logarithm of the minimal angle of resolution) were significantly associated with persistent hypotony (logistic regression: odds ratio, 8.74, 1.37; 95 % CI, 1.89–40.4, 1.03–1.82; P = 0.006, 0.029, respectively).

Conclusions

In the CBIITS, eyes with successful IOP reduction, a limbus-based conjunctival flap, lower preoperative IOP, and choroidal detachment that occurred within 6 months of the surgery were identified as risk factors for persistent hypotony.
Literature
1.
Kupin TH, Juzych MS, Shin DH, Khatana AK, Olivier MM. Adjunctive mitomycin C in primary trabeculectomy in phakic eyes. Am J Ophthalmol. 1995;119:30–9.CrossRefPubMed
2.
Membrey WL, Poinoosawmy DP, Bunce C, Hitchings RA. Glaucoma surgery with or without adjunctive antiproliferatives in normal tension glaucoma. 1. Intraocular pressure control and complications. Br J Ophthalmol. 2000;84:586–90.
3.
Bindlish R, Condon GP, Schlosser JD, D’Antonio J, Lauer KB, Lehrer R. Efficacy and safety of mitomycin-C in primary trabeculectomy: five-year follow-up. Ophthalmology. 2002;109:1336–41.CrossRefPubMed
4.
Gedde SJ, Schiffman JC, Feuer WJ, Herndon LW, Brandt JD, Budenz DL, et al. Treatment outcomes in the Tube Versus Trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol. 2012;153:789–803 e2.CrossRefPubMedPubMedCentral
5.
Kirwan JF, Lockwood AJ, Shah P, Macleod A, Broadway DC, King AJ, et al. Trabeculectomy in the 21st century: a multicenter analysis. Ophthalmology. 2013;120:2532–9.CrossRefPubMed
6.
Higashide T, Ohkubo S, Sugiyama K. Long-term outcomes and prognostic factors of trabeculectomy following intraocular bevacizumab injection for neovascular glaucoma. PLoS One. 2015;10(8):e0135766.CrossRefPubMedPubMedCentral
7.
Iverson SM, Bhardwaj N, Shi W, Sehi M, Greenfield DS, Budenz DL, et al. Surgical outcomes of inflammatory glaucoma: a comparison of trabeculectomy and glaucoma-drainage-device implantation. Jpn J Ophthalmol. 2015;59:179–86.CrossRefPubMed
8.
Heuer DK, Barton K, Grehn F, Shaarawy T, Sherwood M. Consensus on definitions of success. In: Shaarawy TM, Sherwood MB, Grehn F, editors. WGA guidelines on design and reporting of glaucoma surgical trials. Amsterdam: Kugler; 2009. p. 15–24.
9.
Alwitry A, Patel V, King AW. Fornix vs limbal-based trabeculectomy with mitomycin C. Eye (Lond). 2005;19:631–6.CrossRef
10.
Wells AP, Cordeiro MF, Bunce C, Khaw PT. Cystic bleb formation and related complications in limbus- versus fornix-based conjunctival flaps in pediatric and young adult trabeculectomy with mitomycin C. Ophthalmology. 2003;110:2192–7.CrossRefPubMed
11.
Yamamoto T, Kuwayama Y, Collaborative Bleb-related Infection Incidence and Treatment Study Group. Interim clinical outcomes in the collaborative bleb-related infection incidence and treatment study. Ophthalmology. 2011;118:453–8.CrossRefPubMed
12.
Yamamoto T, Sawada A, Mayama C, Araie M, Ohkubo S, Sugiyama K, et al. The 5-year incidence of bleb-related infection and its risk factors after filtering surgeries with adjunctive mitomycin C: collaborative bleb-related infection incidence and treatment study 2. Ophthalmology. 2014;121:1001–6.CrossRefPubMed
13.
Sugimoto Y, Mochizuki H, Ohkubo S, Higashide T, Sugiyama K, Kiuchi Y. Intraocular pressure outcomes and risk factors for failure in the Collaborative Bleb-Related Infection Incidence and Treatment Study. Ophthalmology. 2015;122:2223–33.CrossRefPubMed
14.
Yokota S, Takihara Y, Inatani M. Limbus- versus fornix-based trabeculectomy for open-angle glaucoma eyes with prior ocular surgery: the Collaborative Bleb-Related Infection Incidence and Treatment Study. Sci Rep. 2015;5:9290.CrossRefPubMedPubMedCentral
15.
Saito Y, Higashide T, Takeda H, Ohkubo S, Sugiyama K. Beneficial effects of preoperative intravitreal bevacizumab on trabeculectomy outcomes in neovascular glaucoma. Acta Ophthalmol. 2010;88:96–102.CrossRefPubMed
16.
Budenz DL, Schwartz K, Gedde SJ. Occult hypotony maculopathy diagnosed with optical coherence tomography. Arch Ophthalmol. 2005;123:113–4.CrossRefPubMed
17.
Vesti E. Development of cataract after trabeculectomy. Acta Ophthalmol (Copenh). 1993;71:777–81.CrossRef
18.
Zahid S, Musch DC, Niziol LM, Lichter PR, Collaborative Initial Glaucoma Treatment Study Group. Risk of endophthalmitis and other long-term complications of trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS). Am J Ophthalmol. 2013;155:674–80 680.e1.CrossRefPubMed
19.
Saeedi OJ, Jefferys JL, Solus JF, Jampel HD, Quigley HA. Risk factors for adverse consequences of low intraocular pressure after trabeculectomy. J Glaucoma. 2014;23:e60–8.CrossRefPubMed
20.
Jamil AL, Mills RP. Glaucoma tube or trabeculectomy? That is the question. Am J Ophthalmol. 2007;143:141–2.CrossRefPubMed
21.
Shigeeda T, Tomidokoro A, Chen YN, Shirato S, Araie M. Long-term follow-up of initial trabeculectomy with mitomycin C for primary open-angle glaucoma in Japanese patients. J Glaucoma. 2006;15:195–9.CrossRefPubMed
22.
Jongsareejit B, Tomidokoro A, Mimura T, Tomita G, Shirato S, Araie M. Efficacy and complications after trabeculectomy with mitomycin C in normal-tension glaucoma. Jpn J Ophthalmol. 2005;49:223–7.CrossRefPubMed
23.
Morita K, Gao Y, Saito Y, Higashide T, Kobayashi A, Ohkubo S, et al. In vivo confocal microscopy and ultrasound biomicroscopy study of filtering blebs after trabeculectomy: limbus-based versus fornix-based conjunctival flaps. J Glaucoma. 2012;21:383–91.CrossRefPubMed
24.
Labbé A, Dupas B, Hamard P, Baudouin C. In vivo confocal microscopy study of blebs after filtering surgery. Ophthalmology. 2005;112:1979–86.CrossRefPubMed
25.
Solus JF, Jampel HD, Tracey PA, Gilbert DL, Loyd TL, Jefferys JL, et al. Comparison of limbus-based and fornix-based trabeculectomy: success, bleb-related complications, and bleb morphology. Ophthalmology. 2012;119:703–11.CrossRefPubMed
26.
Song A, Scott IU, Flynn HW Jr, Budenz DL. Delayed-onset bleb-associated endophthalmitis: clinical features and visual acuity outcomes. Ophthalmology. 2002;109:985–91.CrossRefPubMed
27.
Yamamoto T, Kuwayama Y, Nomura E, Tanihara H, Mori K, Japan Glaucoma Society Survey of Bleb-related Infection. Changes in visual acuity and intra-ocular pressure following bleb-related infection: the Japan Glaucoma Society Survey of Bleb-related Infection Report 2. Acta Ophthalmol. 2013;91:e420–6.CrossRefPubMed
28.
Sawada A, Kuwayama Y, Yamamoto T. Changes in filtering bleb morphology after bleb-related infection. Jpn J Ophthalmol. 2015;59:312–7.CrossRefPubMed
29.
Soltau JB, Rothman RF, Budenz DL, Greenfield DS, Feuer W, Liebmann JM, et al. Risk factors for glaucoma filtering bleb infections. Arch Ophthalmol. 2000;118:338–42.CrossRefPubMed
30.
Jampel HD, Quigley HA, Kerrigan-Baumrind LA, Melia BM, Friedman D, Barron Y, et al. Risk factors for late-onset infection following glaucoma filtration surgery. Arch Ophthalmol. 2001;119:1001–8.CrossRefPubMed
31.
Poulsen EJ, Allingham RR. Characteristics and risk factors of infections after glaucoma filtering surgery. J Glaucoma. 2000;9:438–43.CrossRefPubMed
32.
Zacharia PT, Deppermann SR, Schuman JS. Ocular hypotony after trabeculectomy with mitomycin C. Am J Ophthalmol. 1993;116:314–6.CrossRefPubMed
Metadata
Title
Persistent hypotony after trabeculectomy: incidence and associated factors in the Collaborative Bleb-Related Infection Incidence and Treatment Study
Authors
Tomomi Higashide
Shinji Ohkubo
Yosuke Sugimoto
Yoshiaki Kiuchi
Kazuhisa Sugiyama
Publication date
01-07-2016
Publisher
Springer Japan
Published in
Japanese Journal of Ophthalmology / Issue 4/2016
Print ISSN: 0021-5155
Electronic ISSN: 1613-2246
DOI
https://doi.org/10.1007/s10384-016-0450-4

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