September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Effect and Risk Factor for Failure of Trabeculectomy in the Glaucoma Patients with Low Baseline Intraocular Pressure in the Collaborative Bleb-Related Infection Incidence and Treatment Study
Author Affiliations & Notes
  • Yosuke Miyoshi
    Ophthalmology, Hiroahima University Hospital, Hiroshima, Japan
  • Hajime Sakata
    Ophthalmology, Hiroahima University Hospital, Hiroshima, Japan
  • Yoshiaki Kiuchi
    Ophthalmology, Hiroahima University Hospital, Hiroshima, Japan
  • Yosuke Sugimoto
    Ophthalmology, Hiroshima Prefectural Hospital, Hiroshima, Japan
  • Yumiko Murakami
    Ophthalmology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
  • Tomomi Higashide
    Ophthalmology, Kanazawa University Hospital, Kanazawa, Japan
  • Kazuhisa Sugiyama
    Ophthalmology, Kanazawa University Hospital, Kanazawa, Japan
  • Footnotes
    Commercial Relationships   Yosuke Miyoshi, None; Hajime Sakata, None; Yoshiaki Kiuchi, None; Yosuke Sugimoto, None; Yumiko Murakami, None; Tomomi Higashide, None; Kazuhisa Sugiyama, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 2946. doi:
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      Yosuke Miyoshi, Hajime Sakata, Yoshiaki Kiuchi, Yosuke Sugimoto, Yumiko Murakami, Tomomi Higashide, Kazuhisa Sugiyama; Effect and Risk Factor for Failure of Trabeculectomy in the Glaucoma Patients with Low Baseline Intraocular Pressure in the Collaborative Bleb-Related Infection Incidence and Treatment Study. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2946.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To evaluate the efficacy and safety of trabeculectomy for glaucoma patients with low baseline intraocular pressure (IOP) who were enrolled in the Collaborative Bleb-related Infection Incidence and Treatment Study (CBIITS).

Methods : This is a multicenter, prospective, cohort study. A total of 295 eyes in 295 patients with glaucoma who had undergone trabeculectomy alone or trabeculectomy combined with phacoemulsification with low baseline IOP (IOPs < 22 mmHg before surgery) at 34 clinical centers were examined in this study.
The enrollment period was 2 years, and follow-up was conducted every 6 months for up to 5 years. Outcomes were measured at 6-month intervals. Two levels of success were defined by achievement of the following IOP: (A) The patients that 20% of IOP reduction were obtained, (B) the patients that 30% of IOP reduction were obtained. The primary outcome was the qualified success rate according to the defined criteria. The secondary outcomes included IOP, risk factors for surgical failure, and surgical complications.

Results : Mean IOP and preoperative antiglaucoma medications were significantly decreased from 16.7±2.7 to 11.6±4.0 mmHg (P < 0.0001) and from 2.7±1.1 to 1.0±1.2 (P < 0.0001), respectively, 5 years after surgery. For criteria A and B, the qualified success rates were 94.9% and 74.1% at 1 year, respectively, and 87.3% and 42.0% at 5 years, respectively. The third or subsequent trabeculectomy was less effective than the first and second trabeculectomies. The needling procedure and laser suture lysis were associated with the risk of failure. The rates of postoperative hyphema, shallow anterior chamber, bleb leak, and choroidal detachment were 2.3%, 2.0%, 3.4%, and 2.0%, respectively, in our series.

Conclusions : Trabeculectomy with mitomycin C is an effective and safe procedure for reducing IOP in the patients in the CBIITS even if preoperative IOP was low. The number of previous glaucoma surgeries, preoperative IOP, the needling procedure and laser suture lysis after trabeculectomy influenced the success rate, as determined by the target IOP.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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