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The characteristics of the conjunctival bleb are some of the most important factors for the surgical success of glaucoma filtering surgery. To improve surgical outcome, we investigated bleb histology after 3 different glaucoma surgeries. Surgery was performed in 21 white rabbits. Rabbits were randomized to trabeculectomy or implantation with EX-PRESS or a silicone tube (each n = 7). Bleb survival, intraocular pressure (IOP), and vascularity were evaluated. At 6 weeks, eyes were enucleated for histological analysis. Postoperative IOP at 2 weeks was significantly lower in the trabeculectomy and the EX-PRESS group than in the silicone tube group (p = 0.037) but not thereafter. Postoperative bleb survival (p = 0.542) and vascularity (p = 0.988) were similar among the 3 groups. Histologically, a capsule showing mild fibroblast proliferation associated with intercellular collagen was present around the surgical site. The thickness of the bleb was similar among all experimental groups, but it was significantly greater than in controls (p < 0.05). The inflammatory area did not differ between the EX-PRESS and the silicone tube group but was significantly greater in the trabeculectomy group than in the tube group (p = 0.031). A correlation between the thickness of the bleb wall and inflammation was found (r = 0.56, p < 0.01). EX-PRESS and silicone tube implants appear to be relatively inert, with little difference in biocompatibility and bleb survival. Since some degree of inflammation was still observed histologically in the bleb, more noninvasive surgical methods and more biocompatible materials may be desirable., (© 2020 The Author(s) Published by S. Karger AG, Basel.)

Background: To investigate the long-term outcome of trabeculotomy and to compare it with that of trabeculectomy., Methods: We retrospectively reviewed the medical records of patients who had undergone standalone trabeculotomy. Inclusion criteria included a follow-up period of at least 6 years, availability of reliable static visual field results, etc. Age- and preoperative intraocular pressure -matched trabeculectomy cases served as controls. A Kaplan-Meier analysis was employed as a measure of surgical success. Additional clinical factors were also analyzed., Results: Twenty-five eyes of 25 trabeculotomy patients and 20 eyes of 20 trabeculectomy patients with a mean postoperative follow-up period of 8.0 years were selected. The Kaplan-Meier analysis estimated that the success probability defined as intraocular pressure < 16 mmHg was 44.0 ± 9.9% and 75.0 ± 9.7% at 6 years for trabeculotomy and trabeculectomy, respectively. The final mean deviation significantly progressed in trabeculotomy cases in Central 30-2 programs of the Humphrey Field Analyzer (P = 0.025). Patient characteristics and postoperative clinical data were analyzed by Mann-Whitney's U test and Wilcoxon signed-rank test., Conclusions: While trabeculotomy was inferior to trabeculectomy in terms of intraocular pressure control and visual field stability in our series, surgical indications should always be determined on an individual basis, pending further research.

Purpose: To evaluate the standards of harm reporting for glaucoma surgical trials and to develop a classification system for reporting surgical complication severity., Design: Systematic review and Delphi consensus method., Methods: Systematic review of glaucoma surgical trials published from January 2010 until July 2017 with a quality assessment against the CONSORT checklist for harm. A Delphi method was employed to generate consensus grading (interquartile range ≤ 2) among international glaucoma experts (n = 43) on severity of glaucoma surgical complications, and specifically for trabeculectomy and aqueous shunt complications, from 1 (no clinical significance) to 10 (most severe complication)., Results: Forty-seven studies were eligible. The items of the CONSORT checklist for harm that were most frequently missing were use of a validated instrument to report severity (0%), withdrawals due to harm, and subgroup analyses, both reported in 3 publications (6.4%). Most glaucoma experts participating in the Delphi process (80%) completed the second round, and consensus was achieved for all but 1 complication. The least severe complications (graded 2) were "transient loss of vision," "early low intraocular pressure," "choroidal detachment anterior to equator," "small layered hyphema < 1 mm," and "increased lens opacity not clinically significant." The most severe complications (graded 10) were "endophthalmitis" and "permanent severe loss of vision (hand movements or worse).", Conclusions: Glaucoma surgical randomized controlled trials report frequency of complications, but their severity is rarely reported. The quality of harm reporting is poor. We propose the use of a newly developed system of classification for assessing the severity of surgical complications based on consensus., (Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare changes in the macular ganglion cell layer and inner plexiform layer (mGCIPL) thickness over 5 years between surgically treated eyes (STE) and medically treated eyes (MTE) with advanced glaucoma., Design: Retrospective, comparative case series., Methods: Eighty-six patients comprising 43 with open-angle glaucoma (OAG) with trabeculectomy and 43 with medically treated OAG. The mGCIPL thickness was measured more than 5 times during follow-up by optical coherence tomography. Main outcome measure was differences in mGCIPL thickness thinning rate between the groups., Results: The mean age at study initiation was 62.5 ± 9.2 years in STE and 62.7 ± 9.5 years in MTE. The mean deviations (MD), according to the Humphrey Field Analyzer central program 30-2, and the mGCIPL thickness in each sector showed no significant differences at initial measurement. The averaged intraocular pressure (IOP) throughout follow-up was 10.5 ± 2.0 mm Hg in STE and 10.8 ± 0.8 mm Hg in MTE (P = .429; Mann-Whitney U test). There was no significant difference in the MD changes over 5 years between the 2 groups (P = .405; Mann-Whitney U test). Changes in the mGCIPL thickness over 5 years in MTE were significantly greater than that in STE in all sectors (all 6 sectors P < .0001, Mann-Whitney U test). The IOP fluctuation over 5 years in STE was significantly less than that in MTE (P < .0001, Mann-Whitney U test)., Conclusions: The structure of the mGCIPL was better preserved in STE than in MTE, even when the IOPs during follow-up were similar., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: To investigate the impact of surgical or medical reduction of intraocular pressure (IOP) on progressive normal-tension glaucoma followed up over 15 years., Methods: Sixty eyes of 60 patients were divided into 3 intervention groups: group 1 (trabeculectomy, n = 17); group 2 (IOP reduction rate ≥15% with prostaglandin analogs, n = 24); and group 3 (IOP reduction rate <15% with prostaglandin analogs, n = 19). The preintervention and postintervention mean deviation (MD) slopes and IOP were compared. Factors associated with the rate of visual field progression were identified by multiple regression analysis., Results: The mean follow-up was 19.8 years. In group 1, the preintervention and postintervention IOPs were 14.7 ± 1.3 and 9.1 ± 2.0 mmHg, respectively (P < .001, 38% reduction). The MD slope decreased significantly after trabeculectomy (-0.86 ± 0.51 versus -0.19 ± 0.20 dB/y; P < .001). In group 2, the preintervention and postintervention IOPs were 14.7 ± 1.5 and 11.7 ± 1.2 mmHg, respectively (P < 0.001, 20% reduction), with significant differences in the MD slope (-0.52 ± 0.37 versus -0.31 ± 0.30 dB/y; P = .019). In group 3, the preintervention and postintervention IOPs were 14.4 ± 1.8 and 13.2 ± 1.6 mmHg, respectively (P < 0.001, 8% reduction), with no differences in the MD slope (-0.40 ± 0.27 versus -0.50 ± 0.65 dB/y; P > .05). Multiple regression analysis showed that the average IOP, IOP reduction rate, and preintervention MD slope were related to the extent of the postintervention reduction in the MD slope. The difference in the preintervention and postintervention MD slopes significantly correlated with the rate of IOP reduction (r = 0.559, P < .001)., Conclusions: A pressure-dependent maintenance effect of the visual field was confirmed in progressive normal-tension glaucoma.

Purpose: To report the 5-year incidence of visual impairment after mitomycin C-augmented trabeculectomy (MMC trabeculectomy) and the risk factors for visual impairment., Methods: This is a multicentre prospective observational cohort study. Among glaucoma patients registered in the Collaborative Bleb-related Infection Incidence and Treatment Study performed in Japan, the patients with eyes meeting the following qualifications were included: eyes with primary open-angle glaucoma; eyes with primary angle-closure glaucoma; eyes with exfoliative glaucoma; eyes with ≥3/60 in blindness analysis; and eyes with ≥20/60 in low-vision analysis and visual acuity loss analysis. The patients were followed at 6-month intervals for 5 years. The entry data and follow-up data were analysed to determine the incidence of blindness (<3/60), low vision (≥3/60 and <20/60) and visual acuity loss (≥0.2 logMAR) during the follow-up period. Risk factors for visual impairment were also analysed., Results: A total of 694 eyes of 694 or 559 eyes of 559 glaucoma patients were subjected to the blindness analysis or the low-vision and visual acuity loss analysis, respectively. Visual acuity significantly deteriorated (p < 0.0001): 12.2% (95%CI: 9.8-14.7%) of the patients became blind; 12.1% (95%CI: 9.4-14.9%) were judged to have low vision at the final examination; 28.3% (95%CI: 24.5-32.0%) were judged to have visual acuity loss. Glaucoma subtypes, poor preoperative visual function and postoperative complications are the main risk factors for visual impairment., Conclusions: Visual acuity was significantly reduced after MMC trabeculectomy in 5 years, and we identified several risk factors associated with this complication., (© 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Objective: To compare surgical outcomes between the first and second operated eyes in patients who underwent trabeculectomy in both eyes., Methods: This retrospective clinical cohort study at five clinical centers in Japan included 84 patients with open-angle glaucoma who underwent primary trabeculectomy in both eyes. The primary outcome was surgical success or failure, with failure being defined according to three criteria: <20% reduction of the preoperative intraocular pressure (IOP), or Criterion A, IOP >21 mmHg; Criterion B, IOP >18 mmHg; or Criterion C, IOP >15 mmHg. Cases of reoperation, a loss of light perception vision, or hypotony were also considered as "failures"., Results: There were no significant differences in success rate for any of the three criteria between the first and second operated eyes. For patients whose first trabeculectomy was successful, when the second trabeculectomy was performed ≥2 months after the first, the survival curves for all three criteria for the second trabeculectomy were significantly worse than those for patients waiting a shorter interval between trabeculectomies (Criterion A, 52.0% vs 83.6%, P = 0.0031; Criterion B, 51.5% vs 80.4%, P = 0.026; Criterion C, 51.1% vs 80.4%, P = 0.048). In multivariable analyses, a longer interval between trabeculectomies was a significant prognostic factor for surgical failure (Criterion A, P = 0.0055; Criterion B, P = 0.0023; Criterion C, P = 0.027). However, no dependency on the interval between trabeculectomies was found among patients whose first trabeculectomy failed., Conclusions: If the first trabeculectomy is successful, a long interval before the second trabeculectomy increases the risk of surgical failure in the second eye. This result has clinical implications for developing surgical strategies for patients with bilateral glaucoma., Competing Interests: The authors have declared that no competing interests exist.

Purpose: To determine whether the bacterial and floral patterns on the bleb surface are affected by the season in eyes that had undergone trabeculectomy with adjunctive mitomycin C., Patients and Methods: Forty-four glaucoma patients who had an avascular or a hypovascular cystic filtering bleb were studied. Swabs of the bleb surface were taken 4 times in 1 year. The samples were cultured, and all organisms isolated were identified and tested for antibiotic sensitivity and resistance., Results: Of the 176 specimens, 48 tested positive in cultures. Out of the 44 glaucoma eyes that had undergone trabeculectomy, 30 (68.2%) eyes were culture positive. A total of 58 strains were isolated. The organisms isolated were 22 strains of Staphylococcus epidermidis, 21 strains of Propionibacterium acnes, 8 strains of Corynebacterium sp., 5 strains of Staphylococcus sp., and 1 strain of both Neisseria sp., and Candida parapsilosis. Fifteen eyes had a positive culture ≥2 times, and in 10 of these eyes, the same strain was isolated. There was no resistance to vancomycin by S. epidermidis, P. acnes, and Corynebacterium sp. All of the isolates of S.epidermidis were sensitive to minocycline and amikacin. The rate of bacterial detection in the spring was 13.6%, summer was 20.5%, autumn was 45.5%, and winter was 29.5%. The increase in the incidence of bacterial presence during autumn was significant (P=0.006; the Fisher exact probability test)., Conclusions: It is not rare to detect the bacterial organisms on the bleb surface in glaucomatous eyes that had undergone trabeculectomy. The prevalence varied with the season and was highest in the autumn.

Purpose: To verify, by use of data collected by the Japan Glaucoma Society Survey of Bleb-related Infection (JGSSBI), that bleb morphology changes within 12 months of the development of bleb-related infection., Methods: JGSSBI data from 57 eyes of 57 patients with primary open-angle glaucoma and normal tension glaucoma who developed a bleb-related infection were analyzed. Morphological features of the blebs were graded by use of a predetermined grading system. Multiple logistic regression analysis was conducted to identify factors relating to bleb morphology which were associated with poor outcome., Results: Bleb sizes, including both circumferential and tangential lengths, were significantly smaller for stage IIIa/IIIb infections than for stage I/II bleb infections (P = 0.009 and P = 0.026 for the circumferential and tangential lengths, respectively; Fisher's direct probability test). The bleb wall also became significantly thicker during stage IIIa/IIIb infections (P = 0.003). After infection, intraocular pressure (IOP) increased significantly for all cases but was no different in the three subgroups (i.e. stage I, stage II, and stage IIIa/IIIb bleb infections). Multiple logistic regression analysis revealed that a stage III infection was significantly associated with a poor outcome for the bleb., Conclusions: This study revealed that the filtering bleb became smaller, both tangentially and circumferentially, and thicker, after stage III infections than after stage I or II infections.

Purpose: To estimate the risk of blindness following bleb-related infection after trabeculectomy with mitomycin C in open angle glaucoma, utilizing data obtained from two prospective multicenter studies., Methods: The incidence of bleb-related infection in open angle glaucoma after the first or second glaucoma surgery was calculated using a Kaplan-Meier analysis and data from the Collaborative Bleb-related Infection Incidence and Treatment Study (CBIITS). The rate of blindness following bleb-related infection was calculated using data from the Japan Glaucoma Society Survey of Bleb-related Infection (JGSSBI). Finally, the rate of blindness following bleb-related infection after filtering surgery was estimated based on the above two data sets. Blindness was defined as an eye with a visual acuity of 0.04 or less., Results: The incidences of development of bleb-related infection at 5 years were 2.6 ± 0.7 % (calculated cumulative incidence ± standard error) for all infections and 0.9 ± 0.4 % for endophthalmitis in all cases in the CBIITS data. The rates of blindness in the JGSSBI data were 14 % for the total cases with bleb-related infection and 30 % for the endophthalmitis subgroup. The rate of blindness developing within 5 years following trabeculectomy was estimated to be approximately 0.24-0.36 %., Conclusions: The rate of blindness following bleb-related infection within 5 years after trabeculectomy is considerable and thus careful consideration must be given to the indication for trabeculectomy and the selection of surgical techniques.

Purpose: To report the 5-year incidence of bleb-related infection after mitomycin C-augmented glaucoma filtering surgery and to investigate the risk factors for infections., Design: Prospective, observational cohort study., Participants: A total of 1098 eyes of 1098 glaucoma patients who had undergone mitomycin C-augmented trabeculectomy or trabeculectomy combined with phacoemulsification and intraocular lens implantation performed at 34 clinical centers., Methods: Patients were followed up at 6-month intervals for 5 years, with special attention given to bleb-related infections. The follow-up data were analyzed via Kaplan-Meier survival analysis and the Cox proportional hazards model., Main Outcome Measures: Incidence of bleb-related infection over 5 years and risk factors for infections., Results: Of the 1098 eyes, a bleb-related infection developed in 21 eyes. Kaplan-Meier survival analysis revealed that the incidence of bleb-related infection was 2.2±0.5% (cumulative incidence ± standard error) at the 5-year follow-up for all cases, whereas it was 7.9±3.1% and 1.7±0.4% for cases with and without a history of bleb leakage, respectively (P = 0.000, log-rank test). When only eyes with a well-functioning bleb were counted, it was 3.9±1.0%. No differences were found between the trabeculectomy cases and the combined surgery cases (P = 0.398, log-rank test) or between cases with a fornix-based flap and those with a limbal-based flap (P = 0.651, log-rank test). The Cox model revealed that a history of bleb leakage and younger age were risk factors for infections., Conclusions: The 5-year cumulative incidence of bleb-related infection was 2.2±0.5% in eyes treated with mitomycin C-augmented trabeculectomy or trabeculectomy combined with phacoemulsification and intraocular lens implantation in our prospective, multicenter study. Bleb leakage and younger age were the main risk factors for infections., (Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare the posture-induced IOP changes in medically treated eyes with those in surgically treated eyes having open-angle glaucoma (OAG) and low IOP., Methods: Fifty-one posttrabeculectomized OAG eyes with a cystic filtering bleb and 51 nonoperated, medically treated OAG eyes were studied. The IOP measured with a Goldmann applanation tonometer (GAT) was 12 mm Hg or less in both groups. It was measured in the sitting and lateral decubitus positions with a rebound tonometer. The IOP was measured in the upper eye 5 minutes after assuming the lateral decubitus position., Results: The mean (SD) IOP measured with the GAT was 9.7 (1.5) mm Hg in the trabeculectomized eyes and 9.7 (1.4) mm Hg in the medically treated eyes (P = 0.892, unpaired t-test). In the surgically treated group, the mean (SD) IOP measured with the rebound tonometer was 10.3 (2.3) mm Hg in the sitting position and 11.3 (2.8) mm Hg in the lateral decubitus position (P < 0.001, paired t-test). In the medically treated group, the mean (SD) IOP measured with the rebound tonometer was 10.8 (2.0) mm Hg in the sitting position and 14.1 (2.9) mm Hg in the lateral decubitus position (P < 0.001, paired t-test). The greater IOP increase of 3.3 mm Hg in the medically treated group compared with the 1.0 mm Hg in the surgically treated group was significant (P < 0.001, unpaired t-test)., Conclusions: The lower posture-induced IOP change in the successfully trabeculectomized eyes indicates that trabeculectomy will not only lead to a decrease in the IOP but also lower the posture-induced IOP change.

Introduction: To determine whether trabeculectomy affects postural-induced changes in intraocular pressure (IOP), and whether it is maintained., Methods: Thirty-six eyes of 36 patients with open-angle glaucoma who were scheduled for their initial trabeculectomy with adjunctive mitomycin C were prospectively examined. The IOP was measured in the sitting and the lateral decubitus position with an ICare rebound tonometer before, and 1, 3, and 12 months after trabeculectomy., Results: Twenty-nine eyes of 29 patients completed this study. The mean baseline IOP measured with the ICare tonometer was 17.4 ± 4.9 mmHg in the sitting position and 21.3 ± 5.6 mmHg in the lateral decubitus position (p < 0.001). This postural IOP difference, +3.9 mmHg, was reduced to +1.3 ± 1.7 mmHg at 1 month and to +0.8 ± 1.5 mmHg at 3 months after the trabeculectomy (p < 0.001 and p = 0.004 respectively). This decrease in the degree of posture-dependent IOP change was maintained at +1.7 ± 2.2 mmHg at 1 year postoperatively (p < 0.001). In three cases, the postural IOP changes returned to the baseline level, and all three had a failed bleb., Conclusions: Our results indicate that trabeculectomy not only reduces the IOP but also reduces the degree of posture-induced changes in the IOP. Our findings also speculate that measuring the postural IOP changes after trabeculectomy might provide a clue on the functioning of a filtering bleb.

Purpose: To introduce the Collaborative Bleb-related Infection Incidence and Treatment Study and to provide an interim, 2.5-year follow-up report of the findings. This prospective study sought to determine the incidence, severity, and prognosis of bleb-related infection and to investigate the efficacy of the antibacterial therapy in preventing it., Design: Prospective cohort study., Participants: A total of 908 eyes of 908 glaucoma patients who had undergone mitomycin C-augmented trabeculectomy or trabeculectomy combined with phacoemulsification and intraocular lens implantation performed at 34 clinical centers., Methods: Outcomes were measured at 6-month intervals, with special attention to bleb-related infections, and data for 2.5 years of follow-up result were summarized., Main Outcome Measures: The incidence and severity of bleb-related infection., Results: Of the 908 eyes, 9 eyes developed a bleb-related infection. The Kaplan-Meier survival analysis revealed that the probability of development of bleb-related infection was 1.5±0.6% (cumulative probability ± standard error) at the 2.5-year follow in the trabeculectomy cases and 1.4±1.0% in the combined surgery cases. It was 1.5% in both cases with a limbal-based flap and in those with a fornix-based flap. It was significantly different between cases with bleb leakage and those without it (P = 0.037; log-rank test)., Conclusions: The cumulative probability of bleb-related infection was prospectively determined to be 1.5±0.6% in eyes treated with mitomycin C-augmented trabeculectomy or trabeculectomy combined with phacoemulsification and intraocular lens implantation at the 2.5-year follow-up in the Collaborative Bleb-related Infection Incidence and Treatment Study., (Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine the target intraocular pressure (IOP) level in normal-tension glaucoma (NTG) for visual field (VF) stability following trabeculectomy., Methods: Forty eyes of 40 patients who underwent trabeculectomy were enrolled in this study. Progression was determined by a decrease in the Advanced Glaucoma Intervention Study VF defect score of four or more points. The Kaplan-Meier life table method was employed to compare the postoperative VF stability with predetermined IOP levels., Results: The mean postoperative follow-up period was 12 years. At the final visit, the IOP was reduced from 15.2 to 9.4 mmHg on average (P < 0.0001). Reductions in IOP of 20% from baseline were achieved in 70.0% of eyes. The cumulative probability of VF stability was 92.7% in patients having an IOP reduction of >20%, whereas all patients in the poorly controlled IOP group showed progression (P < 0.0001). When IOP values of 9, 10, 11, and 12 mmHg were employed as the cutoff, the best VF prognosis was attained in eyes with a postoperative IOP of 10 mmHg., Conclusions: An IOP reduction of at least 20% from baseline or IOP

Purpose: To obtain useful information for the appropriate prevention and treatment of bleb-related infection following trabeculectomy with antiproliferatives., Subjects and Methods: Fifty nine eyes of 57 patients who developed bleb-related infection after trabeculectomy at the Department of Ophthalmology of Gifu University Hospital from January, 1985 to December, 2007 were observed for at least 30 days. We describe the characteristics of the clinical findings, risk factors, treatment, and prognosis related to the use of antiproliferatives and the stages., Results: Bleb leak was considered a significant risk factor. It was highly likely that inferior quadrant trabeculectomy induced endophthalmitis. Bleb-related infection was also observed in patients under treatment with topical antibiotics. The large incidence of patients with blebitis observed recently, requires attention since it may be associated with a recurrence of bleb-related infection. There was an increase in the number of patients who complained of either pain or visual acuity loss and an increase in the bacterial detection ratio which was related to the severity of the disease stage. The prognosis of visual acuity was relatively better with blebitis, and the function of the blebs was also maintained. The period between the onset of subjective symptoms and visit to the eye clinic was shorter in patients with endophthalmitis than in those with other stages. The prognosis of both visual function and intraocular pressure was poor. Endophthalmitis was frequently encountered in the patients who had been treated with 5-fluorouracil., Conclusions: It is important to repair any bleb leak immediately and to maintain the daily hygiene of the bleb. Long-term careful observation is also essential.

Purpose: To report 2 cases of delayed-onset, bleb-related endophthalmitis induced by Gemella species., Methods: Interventional case report., Results: Two patients developed bleb-related ocular infection attributable to Gemella haemolysans and Gemella morbillorum after trabeculectomy with adjunctive mitomycin C. Both patients had thin-walled cystic filtering blebs before ocular infection. One patient underwent urgent vitrectomy with intravitreal injection of ceftazidime and vancomycin. The other received an intraocular injection of vancomycin and ceftazidime. After surgical intervention, 2 cases were administered topical levofloxacin and sulfobenzylpenicillin, and intravenous cefpirome. The DNA from the microorganism was sequenced and identified as G. haemolysans and G. morbillorum., Conclusions: Gemella species should be added to the long list of organisms that may rarely cause bleb-associated endophthalmitis.

Purpose: To report a woman with congenital rubella syndrome of delayed-onset, bleb-related endophthalmitis induced by Streptococcus intermedius., Methods: Interventional case report., Results: A 33-year-old woman who underwent bilateral trabeculectomy with adjunctive mitomycin C, 11 years earlier presented with redness and blurred vision in her right eye. She had received a topical antimicrobial agent because of bleb leak before presentation. She underwent anterior chamber tap and complete vitrectomy with intravitreal antibiotics. Cultures from the vitreous aspirate grew gram-positive cocci. The DNA from the microorganism was sequenced and identified as S. intermedius. Three months after the surgical intervention, her right eye showed no residual inflammation with a best-corrected visual acuity of 30/200., Conclusions: Bleb-associated endophthalmitis caused by S. intermedius is responsive to intravitreal antibiotics and vitrectomy, and special care should be taken to identify a bacterial pathogen.

Purpose: To investigate the effects of reduction of intraocular pressure (IOP) by surgical intervention on the frequency of disc hemorrhages in eyes with primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG)., Design: Retrospective study., Methods: We studied 99 eyes of 99 patients with POAG and 50 eyes of 50 patients with NTG, who underwent trabeculectomy with adjunctive mitomycin C (MMC) and were followed regularly at 1 to 3-month intervals at the Glaucoma Service of Gifu University Hospital. We applied Kaplan-Meier life-table analysis for the detection of disc hemorrhages before and after trabeculectomy., Results: Trabeculectomy significantly reduced IOP (in POAG: 19.6 +/- 4.4 down to 11.1 +/- 4.2 mm Hg; in NTG: 15.3 +/- 1.5 down to 11.3 +/- 4.5 mm Hg; mean +/- SD). Life-table analysis revealed that the final cumulative probability of detecting a disc hemorrhage after surgery in POAG was 5.5 +/- 2.2% (calculated probability +/- SE) and was significantly lower than that (33.4 +/- 7.8%) before surgery (P < 0.0001, log-rank test). Likewise, the final probability after surgery in NTG was 23.1 +/- 6.3% and was significantly lower than that (42.1 +/- 8.8%) before surgery (P = 0.0063, log-rank test)., Conclusions: IOP reduction via surgical intervention significantly decreases the frequency of disc hemorrhages in open-angle glaucoma patients.

Abstract: Purpose: To report the efficacy of the predetermined treatment protocol of the Collaborative Bleb‐related Infection Incidence and Treatment Study (CBIITS) for bleb‐related infection (BRI) patients. Methods: A prospective, observational cohort study was conducted at 34 clinical centres in Japan. Nineteen eyes from 19 patients that developed BRI were treated using the CBIITS protocol at 34 clinical centres. The visual acuity (VA) and intraocular pressure (IOP) were monitored for 6 and 12 months after treatment with the predetermined protocol. Results: The logMAR was 0.623 ± 0.748 (mean ± standard deviation) before the infection developed. It was 1.054 ± 1.156 and 0.950 ± 1.168 at 6 months and 12 months post‐infection, respectively. However, in subgroup analyses, there was no significant decrease in post‐infection logMAR in stages I and II. In contrast, decimal VA was decreased ≥2 lines in all four cases in stage III. The IOP did not change after infection. It was 10.2 ± 5.0 mmHg (range, 3–22 mmHg) before the infection developed, and 12.9 ± 5.2 mmHg (5–24 mmHg) and 10.7 ± 4.7 mmHg (3–18 mmHg) at 6 months and 12 months after infection, respectively. Conclusion: Because of the small number of BRI patients, the superiority of the treatment was not definitively determined. However, VA was almost maintained in stages I and II, and the IOP did not change after infection. Although further study is necessary, the treatment protocol shown in the study might be a valuable treatment regime. [ABSTRACT FROM AUTHOR]

. Purpose: To present clinical features and microbial data for bleb-related infections obtained by the 5-year-long Japan Glaucoma Society Survey of Bleb-related Infection (JGSSBI). Methods: This multicentre prospective observational study was conducted in 82 clinical centres in Japan. A total of 170 bleb-related infections developed in 157 eyes of 156 patients during a 5-year period. The ophthalmological and microbial data were analysed. Results: The patient age at first infection was 59.3 ± 17.7 years [mean ± standard deviation (SD)], and the period between the last glaucoma surgery and the first infection was 6.9 ± 5.8 years (mean ± SD; range: 0.3-41 years). Bleb leakage was noted significantly more frequently in eyes with repeated infections. The stage of infection at diagnosis was stage I in 91 infections (54%), stage II in 30 infections (18%), stage IIIa in 18 infections (11%), and stage IIIb in 31 infections (18%). Staphylococcus species were the most frequently isolated microbe (41%), followed by Streptococcus species (32%). Streptococcus species, coagulase-negative Staphylococcus, Haemophilus influenzae, and Enterococcus species were the major bacteria isolated in the late-stage infections. Conclusions: The JGSSBI project has revealed several characteristics of bleb-related infection in Japan, which include the significance of bleb leakage in the development of repeated infections and the distribution of bacterial isolates. [ABSTRACT FROM AUTHOR]

. Purpose: To identify changes in visual acuity and intra-ocular pressure (IOP) 12 months after the development of bleb-related infection. Methods: Data obtained from 146 eyes of 146 patients with bleb-related infection were analyzed as a part of the Japan Glaucoma Society Survey of Bleb-related Infection. Multiple logistic regression analysis was conducted to identify factors associated with poor prognosis in visual acuity and increased IOP and for being stage III. Results: The logMAR increased by a mean of 0.140, 0.440, 1.099 and 1.122 at 12 months postinfection for stage I, II, IIIa and IIIb infections, respectively. The logMAR was significantly worse at 6 and 12 months postinfection in stage IIIb (p = 0.002 and p = 0.003, respectively; Wilcoxon signed-rank test) and at 6 months postinfection in stage IIIa (p = 0.036). The IOP was significantly elevated following infection in both stage IIIa and stage IIIb (p = 0.028 and p = 0.008 at 6 and 12 months, respectively, for stage IIIa; p = 0.002 and p = 0.005 for stage IIIb). The multiple logistic regression analysis revealed that being stage III and positive culture were significant risk factors for poor outcome for visual acuity (Odds ratio: 9.26 and 6.29, respectively) and that being stage III was a prognostic factor for increased IOP (Odds ratio: 8.33). Pseudophakia or aphakia was significantly associated with stage III and stage IIIb infections (Odds ratio: 2.85 and 6.30). Conclusions: Stage III bleb-related infection causes significant visual loss and IOP elevation within 12 months after development. Therefore, preventative measures should be taken, especially in cases that are pseudophakic or aphakic. [ABSTRACT FROM AUTHOR]

Introduction: To determine whether trabeculectomy affects postural-induced changes in intraocular pressure (IOP), and whether it is maintained. Methods: Thirty-six eyes of 36 patients with open-angle glaucoma who were scheduled for their initial trabeculectomy with adjunctive mitomycin C were prospectively examined. The IOP was measured in the sitting and the lateral decubitus position with an ICare rebound tonometer before, and 1, 3, and 12 months after trabeculectomy. Results: Twenty-nine eyes of 29 patients completed this study. The mean baseline IOP measured with the ICare tonometer was 17.4 ± 4.9 mmHg in the sitting position and 21.3 ± 5.6 mmHg in the lateral decubitus position ( p < 0.001). This postural IOP difference, +3.9 mmHg, was reduced to +1.3 ± 1.7 mmHg at 1 month and to +0.8 ± 1.5 mmHg at 3 months after the trabeculectomy ( p < 0.001 and p = 0.004 respectively). This decrease in the degree of posture-dependent IOP change was maintained at +1.7 ± 2.2 mmHg at 1 year postoperatively ( p < 0.001). In three cases, the postural IOP changes returned to the baseline level, and all three had a failed bleb. Conclusions: Our results indicate that trabeculectomy not only reduces the IOP but also reduces the degree of posture-induced changes in the IOP. Our findings also speculate that measuring the postural IOP changes after trabeculectomy might provide a clue on the functioning of a filtering bleb. [ABSTRACT FROM AUTHOR]

Abstract: Bleb-related infection is a potentially sight-threatening complication of glaucoma filtration surgery. Here, we describe its clinical features and management. Blebitis, or stage I infection, is a mild form of bleb-related infection. The prognosis of blebitis is usually good, unless it has progressed to later stages. Endophthalmitis, or stage II or stage III infection, however, is a much-advanced stage of the infection and has a poorer prognosis. For treatment of bleb-related infections, immediate intensive antibacterial treatment is urgently required. [Copyright &y& Elsevier]

Purpose:To determine the surgical outcome of mitomycin trabeculectomy in patients with refractory glaucoma. Methods:Sixty-six eyes of 52 patients with refractory glaucoma underwent mitomycin trabeculectomy. Mitomycin was applied for five minutes only once during trabeculectomy. The follow-up period was six to 61 months. Results:Cumulative success probability was calculated using Kaplan-Meier life-table analysis assuming the cut-off postoperative IOP to be 20 mmHg or IOP reduction by at least 20% in eyes with preoperative IOP 24mmHg. At the end of 61-month follow-up the success probability was 80%± 6% without postoperative ocular hypotensive medication (complete success) and was 95%± 3% regardless of postoperative antiglaucoma medication (overall success), respectively. Conclusion:The data suggest that mitomycin trabeculectomy is efficacious in reducing IOP in patients with refractory glaucoma. [ABSTRACT FROM AUTHOR]