{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T21:20:48Z","timestamp":1776374448319,"version":"3.51.2"},"reference-count":40,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2022,5,30]],"date-time":"2022-05-30T00:00:00Z","timestamp":1653868800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To investigate potential risk factors, particularly antimetabolite choice, with regard to the development of adverse bleb morphology in eyes that had undergone trabeculectomy surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A single\u2010centre, observational cohort study of 631 consecutive eyes, which had undergone trabeculectomy over an 11\u2010year period. For each case, bleb morphology was recorded at 2\u2009years, and its association with the per\u2010operative antimetabolite as well as potential confounding risk factors was analysed using univariate (unadjusted) and multivariate (adjusted) logistical regression analyses to identify those that could contribute to the development of adverse blebs. A standard protocol for 5\u2010fluorouracil and mitomycin\u2010C utilization was employed in the majority of cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>When 5\u2010fluorouracil was used (<jats:italic>n<\/jats:italic>\u2009=\u2009257), 24% of patients formed cystic or partially cystic blebs, whereas with mitomycin\u2010C (<jats:italic>n<\/jats:italic>\u2009=\u2009299), only 12% formed such adverse blebs, the difference being statistically significant (OR\u2009=\u20093.54, p\u2009=\u20090.002 unadjusted; OR\u2009=\u20097.49, p\u2009=\u20090.00 adjusted). Of the other potential confounding factors, care within the private sector (OR\u2009=\u20090.30 p\u2009=\u20090.02) and a history of previous ocular surgery involving a conjunctival incision were identified as potential risk factors for the formation of adverse cystic blebs (OR\u2009=\u20090.28, p\u2009=\u20090.02).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Modern use of mitomycin\u2010C appeared to be better than 5\u2010fluorouracil as an adjunctive antimetabolite used at the time of trabeculectomy, with respect to the development of preferable final bleb morphology. The only potential preoperative risk factors found to be significant with respect to adverse cystic bleb development were care in the private health sector and previous ocular surgery involving a conjunctival incision.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aos.15193","type":"journal-article","created":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T06:09:51Z","timestamp":1653977391000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The Norwich trabeculectomy study: risk factor analysis for the development of adverse, thin cystic blebs"],"prefix":"10.1111","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2731-0266","authenticated-orcid":false,"given":"Toby S.","family":"Al\u2010Mugheiry","sequence":"first","affiliation":[{"name":"Norfolk &amp; Norwich University Hospital NHS Foundation Trust  Norwich UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allan","family":"Clark","sequence":"additional","affiliation":[{"name":"Norwich Medical School University of East Anglia  Norwich UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David C.","family":"Broadway","sequence":"additional","affiliation":[{"name":"Norfolk &amp; Norwich University Hospital NHS Foundation Trust  Norwich UK"},{"name":"Norwich Medical School University of East Anglia  Norwich UK"},{"name":"School of Pharmacy University of East Anglia  Norwich UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,5,30]]},"reference":[{"key":"e_1_2_5_2_1","first-page":"371","article-title":"The Norwich Trabeculectomy study: long\u2010term outcomes of modern trabeculectomy with respect to risk factors for filtration failure","volume":"5","author":"Broadway DC","year":"2014","journal-title":"Clin Exp Ophthalmol"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9394(98)00045-2"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1994.01090230060021"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9394(00)00901-6"},{"key":"e_1_2_5_6_1","unstructured":"BurchJ AchironA(2017):How does mitomycin C compare with 5\u2010fluorouracil as an antimetabolite adjunct in trabeculectomy surgery for glaucoma? [Cochrane clinical answers web site]. Available at:https:\/\/www.cochranelibrary.com\/cca\/doi\/10.1002\/cca.1571\/full. (Accessed on 30 Mar 2021)."},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00061198-200306000-00015"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.85.6.686"},{"key":"e_1_2_5_9_1","first-page":"172","article-title":"Enhanced intraocular pressure controlling effectiveness of trabeculectomy by local application of mitomycin C","volume":"9","author":"Chen C\u2010W","year":"1983","journal-title":"Trans Asia\u2013Pacific Acad Ophthalmol"},{"key":"e_1_2_5_10_1","first-page":"1487","article-title":"Enhancement of IOP control effect of trabeculectomy by local application of anticancer drug","volume":"2","author":"Chen C\u2010W","year":"1986","journal-title":"ACTA XXV Concilium Ophthamol"},{"key":"e_1_2_5_11_1","first-page":"79","article-title":"La mitomycin C dans la chirurgie des glaucomes [Mitomycin C in glaucoma surgery]","volume":"247","author":"Collignon\u2010Brach J","year":"1993","journal-title":"Bull Soc Belge Ophtalmol"},{"key":"e_1_2_5_12_1","first-page":"1639","article-title":"Effect of varying mitomycin\u2010C treatment area in glaucoma filtration surgery in the rabbit","volume":"38","author":"Cordeiro MF","year":"1997","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/ceo.12097"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2016-EGSguideline.003"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/eye.1991.63"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2415-12-24"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.116.4.443"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(86)33542-5"},{"key":"e_1_2_5_19_1","doi-asserted-by":"crossref","unstructured":"HoffmannEM HerzogD Wasielica\u2010PoslednikJ ButschC&SchusterAK(2019):Bleb grading by photographs versus bleb grading by slit\u2010lamp examination. [Wiley Online Library website.Acta Ophthalmol.]. December 30 2019. Epub ahead of print. Available at:https:\/\/onlinelibrary.wiley.com\/doi\/full\/10.1111\/aos.14335. (Accessed on 8 Apr 2021).","DOI":"10.1111\/aos.14335"},{"key":"e_1_2_5_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(92)31781-6"},{"key":"e_1_2_5_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.icu.0000156138.05323.6f"},{"key":"e_1_2_5_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2013.07.049"},{"key":"e_1_2_5_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1991.01080120077030"},{"key":"e_1_2_5_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02334165"},{"key":"e_1_2_5_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.84.12.1349"},{"key":"e_1_2_5_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1985.01050090150052"},{"key":"e_1_2_5_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(95)31049-4"},{"key":"e_1_2_5_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/ceo.12953"},{"key":"e_1_2_5_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1442-9071.2008.01736.x"},{"key":"e_1_2_5_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(91)32293-0"},{"key":"e_1_2_5_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)61423-7"},{"key":"e_1_2_5_32_1","first-page":"347","article-title":"Low\u2010dose 5\u2010fluorouracil and glaucoma filtration surgery","volume":"20","author":"Rabowsky JH","year":"1989","journal-title":"Ophthalmic Surg"},{"key":"e_1_2_5_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9394(14)70991-2"},{"key":"e_1_2_5_34_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.2005.072884"},{"key":"e_1_2_5_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02028655"},{"key":"e_1_2_5_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9394(89)90853-2"},{"key":"e_1_2_5_37_1","doi-asserted-by":"publisher","DOI":"10.3928\/1542-8877-20000101-06"},{"key":"e_1_2_5_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(03)00800-5"},{"key":"e_1_2_5_39_1","doi-asserted-by":"publisher","DOI":"10.1097\/00061198-200412000-00005"},{"key":"e_1_2_5_40_1","doi-asserted-by":"publisher","DOI":"10.1097\/IJG.0000000000000636"},{"key":"e_1_2_5_41_1","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1993.01090060112033"}],"container-title":["Acta Ophthalmologica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aos.15193","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/aos.15193","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aos.15193","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T13:02:52Z","timestamp":1692536572000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/aos.15193"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,30]]},"references-count":40,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2022,11]]}},"alternative-id":["10.1111\/aos.15193"],"URL":"https:\/\/doi.org\/10.1111\/aos.15193","archive":["Portico"],"relation":{},"ISSN":["1755-375X","1755-3768"],"issn-type":[{"value":"1755-375X","type":"print"},{"value":"1755-3768","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,30]]},"assertion":[{"value":"2022-01-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-05-14","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-05-30","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}