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      Prospective Cohort Study on Refractive Changes after Trabeculectomy

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          Abstract

          We prospectively evaluated refractive changes in the eyes of 97 patients who underwent trabeculectomy at Fukui University Hospital, Fukui, Japan. The primary outcome measure was the refractive change after trabeculectomy. Secondary outcome measures included postoperative complications and prognostic factors for refractive change. We observed a progressive and significant mean refractive myopic shift of −0.80 D at 12 months after surgery. In phakic eyes, the mean myopic refractive shifts progressed significantly by −0.46 D at 3 months after surgery ( P=0.003), by −0.52 D at 6 months ( P=0.012), and by −1.31 D at 12 months ( P < 0.001). In the pseudophakic eyes, we found no significant refraction progression at any of the postsurgery follow-up visits. Our multivariable analyses showed that lens nuclear color grade change was a significant prognostic factor for refractive myopic progression ( P < 0.001). Trabeculectomy causes refractive myopic progression in phakic eyes. Nuclear sclerotic cataract progression is associated with refractive myopic shift after trabeculectomy. This trail is registered with UMIN000007813.

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          Most cited references34

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          Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures

          (1998)
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            Vitrectomy surgery increases oxygen exposure to the lens: a possible mechanism for nuclear cataract formation.

            To report vitreous oxygen tension before, immediately after, and at longer times after vitrectomy. A prospective, interventional consecutive case series. Oxygen was measured using an optical oxygen sensor in patients undergoing vitrectomy. Intraoperatively, oxygen measurements were taken before and after vitrectomy in two intraocular locations: adjacent to the lens and in the mid-vitreous. Sixty-nine eyes underwent oxygen tension measurements at the time of vitrectomy. In baseline eyes, oxygen tension in the vitreous was low, measuring 8.7 +/- 0.6 mm Hg adjacent to the lens and 7.1 +/- 0.5 mm Hg in the mid-vitreous. The difference between the two locations was statistically significant (P < .003), indicating that vitreous gel maintains an intraocular oxygen gradient. Immediately after vitrectomy, oxygen tension in the fluid-filled eye was higher, measuring 69.6 +/-4.8 mm Hg adjacent to the lens and 75.6 +/- 4.1 mm Hg in the mid-vitreous. There was no statistically significant oxygen gradient between the two locations. The difference in oxygen tension pre- and postvitrectomy is highly statistically significant (P < .0001 lens, P < .0001 mid-vitreous). In eyes with a history of vitrectomy and previous removal of the vitreous gel, the intraocular oxygen tension was significantly higher than in eyes with a formed vitreous gel undergoing a first vitrectomy (P < .02 lens, P < .003 mid-vitreous). Vitrectomy surgery significantly increases intraocular oxygen tension during and for prolonged periods after surgery. This exposes the crystalline lens to abnormally high oxygen and may lead to nuclear cataract formation.
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              The Advanced Glaucoma Intervention Study: 8. Risk of cataract formation after trabeculectomy.

              (2001)
              To compare the risk of cataract formation in eyes with and without prior trabeculectomy and to assess other risk factors for cataract. The Advanced Glaucoma Intervention Study (AGIS) has been following 789 eyes in 591 patients with medically uncontrolled open-angle glaucoma. From 1988 to 1992, these eyes were randomly assigned to either an argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy treatment sequence or a trabeculectomy-ALT-trabeculectomy sequence. Cox regression analyses were used to assess risk factors for cataract formation during 7 to 11 years of follow-up. Cataract, defined as either having had cataract surgery or confirmed severe lens opacity with a best-corrected Early Treatment Diabetic Retinopathy Study visual acuity score less than 65 letters (worse than 20/50). Data are presented on the expected 5-year cumulative probability of cataract formation in each randomized sequence by age and presence of diabetes at study entry. Overall, approximately half of the eyes studied developed cataract. A first trabeculectomy, whether as the first or second AGIS intervention, increased the overall risk of cataract by 78% (risk ratio [RR] = 1.78; P<.001). Diabetes (RR = 1.47; P =.004) and age at study entry (RR = 1.07 per year of age; P<.001) were also risk factors for cataract. When postoperative complications of trabeculectomy were included in the analysis, the increased risk of cataract for eyes with a first trabeculectomy reduced to 47% when complications did not occur (RR = 1.47; P =.003) and increased to 104% when complications did occur (RR = 2.04; P<.001). Several specific postoperative complications of trabeculectomy were associated with increased risk of cataract, particularly marked inflammation (RR = 3.29; P<.001) and flat anterior chamber (RR = 1.80; P =.004). Trabeculectomy with complications was also significantly associated with an increased risk of cataract in each of 3 lens regions: nuclear, cortical, and posterior subcapsular. In eyes of AGIS patients, after adjustment for age and diabetes, trabeculectomy increased the risk of cataract formation by 78%.
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                Author and article information

                Contributors
                Journal
                J Ophthalmol
                J Ophthalmol
                JOPH
                Journal of Ophthalmology
                Hindawi
                2090-004X
                2090-0058
                2019
                7 August 2019
                : 2019
                : 4731653
                Affiliations
                Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
                Author notes

                Academic Editor: Luca Agnifili

                Author information
                https://orcid.org/0000-0003-0418-6829
                https://orcid.org/0000-0003-0896-996X
                Article
                10.1155/2019/4731653
                6702848
                609d4dcd-bc5e-4063-99c2-dc04b1457771
                Copyright © 2019 Kentaro Iwasaki et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 January 2019
                : 19 July 2019
                Categories
                Clinical Study

                Ophthalmology & Optometry
                Ophthalmology & Optometry

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