title: Latent Infections as a Risk Factor for Posttrabeculectomy Bleb Failure.
abstract: OBJECTIVE
  To investigate latent conjunctival Chlamydia trachomatis (CT) and Bacteroides fragilis (BF) infections as potential risk factors for posttrabeculectomy bleb failure.
  
  
  METHODS
  This retrospective observational study included 50 primary open-angle glaucoma eyes of 50 patients who were submitted to trabeculectomy without cytostatics from September 2010 to June 2011 and were followed up for at least a year. Preoperatively, conjunctival scrapings were taken and their specimens subjected to polymerase chain reaction, direct fluorescent assay and cell culture testing for CT, and culture for BF on blood agar medium. Serum CT-specific IgG and IgA and tear interleukin (IL)-1β and IL-8 concentrations were measured with enzyme-linked immunosorbent assay. We defined bleb failure as intraocular pressure >21 mm Hg with antiglaucoma medications, resulting from reduced bleb filtration capacity due to bleb fibrosis, fistula obstruction, flattened bleb, or encapsulated bleb, and no earlier than 2 weeks after surgery. At the time of the reintervention, a scleroconjunctival biopsy was obtained for histopathology (including direct fluorescent assay testing for CT). Eyes were divided into a failure group and a nonfailure group, depending on whether they developed bleb failure (required reintervention) or not within a follow-up year.
  
  
  RESULTS
  In the failure group (n=18), the frequencies of detection of CT and BF in conjunctival specimens were 27.8% and 66.7%, respectively, versus 0% and 9.4% in the nonfailure group (n=32). CT and BF were detected in 11.1% and 11.1%, respectively, of scleroconjunctival biopsies. IgG and IgA seropositivity to CT was found in 66.7% and 33.3%, respectively, of the failure group patients, versus 9.4% and 0% of the nonfailure group patients. Tear IL-1β and IL-8 levels were markedly elevated in the failure group (468.83±80.43 and 107.89±15.11 pg/mL, respectively) versus the nonfailure group (22.34±5.43 and 9.34±2.83 pg/mL, respectively).
  
  
  CONCLUSIONS
  Being a contributor to low-grade conjunctival inflammation, latent conjunctival CT, and BF infections in primary open-angle glaucoma patients represent risk factors for posttrabeculectomy bleb failure.
authors: Department of Ophthalmology, Kirov Military Medical Academy, St Petersburg, Russia.
authors: Ernest V
authors: EV
authors: Boiko
authors: Alexei L
authors: AL
authors: Pozniak
authors: Dmitrii I
authors: DI
authors: Iakushev
authors: Dmitrii S
authors: DS
authors: Maltsev
authors: Alexei A
authors: AA
authors: Suetov
authors: Irina V
authors: IV
authors: Nuralova
mesh_terms: D000368:Aged; D000907:Antibodies, Bacterial / Q000097:blood; D001442:Bacteroides Infections / Q000150:complications / Q000175:diagnosis / Q000276:immunology; D001441:Bacteroides fragilis / Q000276:immunology / Q000302:isolation & purification*; D002690:Chlamydia Infections / Q000150:complications / Q000175:diagnosis / Q000276:immunology; D002692:Chlamydia trachomatis / Q000276:immunology / Q000302:isolation & purification*; D003234:Conjunctivitis, Bacterial / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D015818:Eye Infections, Bacterial / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D005136:Eye Proteins / Q000378:metabolism; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D005902:Glaucoma, Open-Angle / Q000601:surgery*; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D053583:Interleukin-1beta / Q000378:metabolism; D016209:Interleukin-8 / Q000378:metabolism; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013666:Tears / Q000378:metabolism; D014065:Tonometry, Ocular; D014130:Trabeculectomy; D017211:Treatment Failure
chemical_list: D000907:Antibodies, Bacterial; C508606:CXCL8 protein, human; D005136:Eye Proteins; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D053583:Interleukin-1beta; D016209:Interleukin-8; C042434:tear proteins