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Acta Ophthalmol. 2018 Mar;96(2):e229-e236. doi: 10.1111/aos.13523. Epub 2017 Nov 8.

Efficacy of predetermined therapeutic measures against bleb-related infection in the Collaborative Bleb-related Infection Incidence and Treatment Study.

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Department of Ophthalmology, Kitasato University Hospital, Kanagawa, Japan.
Department of Ophthalmology, University of the Ryukyus, Faculty of Medicine, Okinawa, Japan.
Department of Ophthalmology, Tokyo Metropolitan Police Hospital, Tokyo, Japan.
Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan.
Department of Ophthalmology, Osaka Koseinenkin Hospital, Osaka, Japan.



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.


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.


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.


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.


bleb-related infection; blebitis; predetermined treatment protocol; trabeculectomy

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