Boiko Ernest V, Pozniak Alexei L, Iakushev Dmitrii I, Maltsev Dmitrii S, Suetov Alexei A, Nuralova Irina V
Department of Ophthalmology, Kirov Military Medical Academy, St Petersburg, Russia.
J Glaucoma. 2016 Mar;25(3):306-11. doi: 10.1097/IJG.0000000000000212.
To investigate latent conjunctival Chlamydia trachomatis (CT) and Bacteroides fragilis (BF) infections as potential risk factors for posttrabeculectomy bleb failure.
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.
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).
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.
研究结膜沙眼衣原体（CT）和脆弱拟杆菌（BF）潜伏感染作为小梁切除术后滤过泡失败的潜在危险因素。
这项回顾性观察性研究纳入了2010年9月至2011年6月期间接受小梁切除术且未使用细胞抑制剂的50例患者的50只原发性开角型青光眼患眼，并进行了至少一年的随访。术前采集结膜刮片，其标本进行聚合酶链反应、直接荧光检测和细胞培养以检测CT，并在血琼脂培养基上培养以检测BF。采用酶联免疫吸附测定法测量血清CT特异性IgG和IgA以及泪液白细胞介素（IL）-1β和IL-8浓度。我们将滤过泡失败定义为使用抗青光眼药物后眼压>21 mmHg，这是由于滤过泡纤维化、瘘管阻塞、滤过泡扁平或包裹性滤过泡导致滤过泡滤过能力降低所致，且不早于术后2周。在再次干预时，获取巩膜结膜活检标本进行组织病理学检查（包括CT的直接荧光检测）。根据随访一年内是否发生滤过泡失败（需要再次干预），将患眼分为失败组和非失败组。
在失败组（n = 18）中，结膜标本中CT和BF的检测频率分别为27.8%和66.7%，而在非失败组（n = 32）中分别为0%和9.4%。在巩膜结膜活检标本中，CT和BF的检测率分别为11.1%和11.1%。失败组患者中CT的IgG和IgA血清阳性率分别为66.7%和33.3%，而非失败组患者分别为9.4%和0%。与非失败组（分别为22.34±5.43和9.34±2.83 pg/mL）相比，失败组的泪液IL-1β和IL-8水平显著升高（分别为468.83±80.43和107.89±15.11 pg/mL）。
原发性开角型青光眼患者结膜CT和BF潜伏感染是低度结膜炎症的一个因素，是小梁切除术后滤过泡失败的危险因素。
