title: Intraocular Pressure Outcomes and Risk Factors for Failure in the Collaborative Bleb-Related Infection Incidence and Treatment Study.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of trabeculectomy for patients with glaucoma who were enrolled in the Collaborative Bleb-related Infection Incidence and Treatment Study (CBIITS).
  
  
  METHODS
  Multicenter, prospective, cohort study.
  
  
  METHODS
  A total of 829 eyes in 829 patients with glaucoma who had undergone trabeculectomy alone or trabeculectomy combined with phacoemulsification at 34 clinical centers were examined in this study.
  
  
  METHODS
  Intraocular pressures (IOPs, in millimeters of mercury), risk factors for surgical failure, and surgical complications.
  
  
  METHODS
  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. Four levels of success were defined by achievement of the following IOP: (A) 4<IOP<22, (B) 4<IOP<19, (C) 4<IOP<16, and (D) 4<IOP<13. 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 24.9±9.0 to 12.6±5.2 mmHg (P<0.0001) and from 2.8±1.0 to 1.2±1.3 mmHg (P<0.0001), respectively, 5 years after surgery. For criteria A, B, C, and D, the qualified success rates were 90.1%, 88.9%, 77.6%, and 57.7% at 1 year, respectively, and 71.9%, 66.7%, 50.1%, and 29.9% at 5 years, respectively. The third or subsequent trabeculectomy was less effective than the first and second trabeculectomies. Preoperative lens status and preoperative higher IOP were risk factors for trabeculectomy failure. The needling procedure and cataract surgery were associated with the risk of failure. The rates of postoperative hyphema, shallow anterior chamber, bleb leak, and choroidal detachment were 2.7%, 3.1%, 1.9%, and 7.2%, respectively, in our series.
  
  
  CONCLUSIONS
  Trabeculectomy with mitomycin C is an effective and safe procedure for reducing IOP in the CBIITS. The number of previous glaucoma surgeries, preoperative lens status and IOP, the needling procedure, and cataract surgery after trabeculectomy influenced the success rate, as determined by the target IOP.
authors.affiliation: Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. Electronic address: sugimoto@hiroshima-u.ac.jp.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Sugimoto
authors.affiliation: Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Mochizuki
authors.affiliation: Department of Ophthalmology and Visual Science, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Ohkubo
authors.affiliation: Department of Ophthalmology and Visual Science, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Higashide
authors.affiliation: Department of Ophthalmology and Visual Science, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Sugiyama
authors.affiliation: Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kiuchi
mesh_terms: D000368:Aged; D000477:Alkylating Agents / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003229:Conjunctival Diseases / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007429:Intraocular Pressure / Q000502:physiology*; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D018918:Phacoemulsification; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology*; D014065:Tonometry, Ocular; D014130:Trabeculectomy / Q000009:adverse effects*; D017211:Treatment Failure
chemical_list: D000477:Alkylating Agents; D000959:Antihypertensive Agents; D016685:Mitomycin