Imaging of Trabeculectomy Blebs Using Anterior Segment Optical Coherence Tomography (original) (raw)
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Morphology of functioning trabeculectomy blebs using anterior segment optical coherence tomography
Indian Journal of Ophthalmology, 2014
To image trabeculectomy blebs using anterior segment optical coherence tomography (AS-OCT), and to correlate the bleb morphologic features at one month postoperatively with bleb function at six months. Materials and Methods: This prospective, observational study included 56 eyes undergoing trabeculectomy with MMC, followed up for minimum of six months. Postoperatively, bleb imaging was done using AS-OCT at one and six month. Bleb morphology was assessed for bleb wall reflectivity, bleb pattern in multiform reflectivity, visibility of drainage route and presence of hyper-reflectivity area. Bleb function was considered successful if IOP was <18 mmHg without medication at six month. Bleb morphology one month postoperatively was correlated with bleb function at six months. Results: At six months successful bleb function was noted in 44 (81.5%) eyes. Morphology of bleb at one month showed uniform bleb wall reflectivity in 6 eyes (11%) and multiform wall reflectivity in 48 eyes (89%). In eyes with multiform wall reflectivity, microcysts with multiple layers was seen in 26 eyes (48%), microcysts with subconjunctival separation in 12 eyes (22%) and only microcyst in 10 eyes (19%). When bleb features at one month were correlated with the bleb function at six months, logistic regression analysis revealed that blebs with multiform reflectivity with multiple internal layers with microcysts were associated with higher chances of success (P < 0.001). Conclusion: AS-OCT demonstrated early bleb morphological features that may be used to predict the functioning of a bleb. Multiform bleb wall reflectivity with a pattern of multiple internal layers and microcysts was associated with increased chances of success of a bleb.
Early trabeculectomy bleb walls on anterior-segment optical coherence tomography
Graefe's Archive for Clinical and Experimental Ophthalmology, 2010
Background To correlate the cross-sectional features of filtering blebs on anterior-segment optical coherence tomography (AS-OCT) 2 weeks after trabeculectomy with bleb function at 6 months. Methods Forty-eight eyes followed for 6 months or more after trabeculectomy with mitomycin C were included. Bleb wall reflectivity of developing blebs on AS-OCT 2 weeks postoperatively was correlated with mature bleb function at 6-month postoperative visit. Results Developing bleb walls at 2 weeks were classified as uniform in 10/48 eyes (20.8%) and multiform in 38/48 eyes (79.2%). Blebs with uniform reflectivity were significantly more likely to have worse function at 6 months (P<0.001). Multiform bleb walls had hyporeflective areas seeming to represent loosely-arranged connective tissue (multiple-layer structures), subconjunctival separation, and microcysts. Blebs with multiple-layer structures at 2 weeks were associated with better bleb function at 6 months (P=0.025). Intraocular pressure (IOP) of developing blebs at 2 weeks did not correlate with bleb function at 6 months (P=0.471). Conclusions Bleb wall reflectivity on AS-OCT 2 weeks after surgery may predict bleb function at 6 months, whereas IOP of developing blebs may not.
Case Reports in Ophthalmological Medicine, 2021
Introduction To examine the corneal total higher-order aberrations before and after the excision of an overhanging bleb that developed following trabeculectomy. Case Presentation. Two patients who developed overhanging blebs following trabeculectomy with a fornix-based conjunctival flap using mitomycin C (MMC) were assessed. We measured the corneal total higher-order aberrations for a 4 mm pupil diameter using the TOPCON KR-1W wavefront analyzer and the visual acuity before and after bleb excision. The corneal total higher-order aberration (HOA) improved from 0.50 μm to 0.38 μm in case 1 and from 0.59 μm to 0.49 μm in case 2 after bleb excision. The intraocular pressure was identical before and after bleb excision in both cases. No significant changes in the best-corrected visual acuity (BCVA) were noted in case 1; however, BCVA was improved from 20/25 to 20/20 in case 2. Both cases showed improvements in the symptoms of dysesthesia. Conclusion Excision of the overhanging bleb devel...
Türk Oftalmoloji Dergisi, 2015
Objectives: anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM). Materials and Methods: o parameters such as length, height and bleb wall thickness were assessed by AS-OCT; conjunctival epithelial-stromal cyst, structural network of conjunctival stroma and vascularisation were examined with IVCM. The relation between biomicroscopic morphological staging and bleb characteristics detected on AS-OCT and IVCM were assessed. Results: The mean age of the 28 patients (16 male, 12 female) was 57.2±15.9 (19 to 79) years. The mean time elapsed between surgery and examination was 29.2±19.2 (6 to 68) months. According to biomicroscopic appearance, 17 (60.7%) blebs were functional (13 diffuse, 4 ctional blebs, functional blebs were found to be superior in terms of biometric parameters on AS-OCT assessment (p<0.05). Higher number of epithelial and stromal cysts and less vascularisation were detected by IVCM in functional blebs when compared with non-functional blebs (p<0.05). Conclusion: Besides biomicroscopic examination, which is an easy and practical method for determining bleb morphology, cross-sectional images obtained by AS-OCT and IVCM provide objective data regarding internal structure and functional features of blebs.
Appraisal of Bleb Using Trio of Intraocular Pressure, Morphology on Slit Lamp, and Gonioscopy
Ophthalmology and Eye Diseases, 2016
Purpose The aim of this study was to assess bleb function using Wuerzburg bleb classification score (WBCS) for bleb morphology on slit lamp, intraocular pressure (IOP), and gonioscopy. Methods A total of randomly selected 30 eyes posttrabeculectomy were assessed for bleb function with the trio of bleb morphology, IOP, and gonioscopy. Bleb was assessed using the WBCS of 0–12 on slit lamp, IOP was assessed using applanation tonometry, and visualization of inner ostium and iridectomy were assessed using gonioscopy. Postoperative patients of less than six weeks were excluded from the study. Results The correlation between WBCS and the duration of trabeculectomy was found to be highly significant ( P value = 0.029). The correlation of IOP with WBCS was also found to be strongly positive ( P = 0.000). IOP was found to be highly associated with peripheral iridectomy ( P = 0.000), internal window ( P = 0.001), and bleb characteristics.
Eye, 1987
The bleb which develops following trabeculectomy may be diffuse or cystic in nature. Cystic blebs can be complicated by infection, leakage of aqueous, astigma tism, and problems related to contact lens wear, whereas diffuse blebs are not associated with such problems. We report a preliminary prospective photographic evaluation of bleb formation following each of three types of conjunctival incision: (a) fornix based (b) straight limbus based and (c) curved limbus based. The vascular pattern and morphology of the drainage bleb formed was dependent upon the type of conjunctival incision made. The fornix based flap was found most likely to give rise to a diffuse bleb with a normal vascular pattern.
Assessing the Status of Filtering Blebs at 5 Year Post- Trabeculectomy
Open Access Macedonian Journal of Medical Sciences, 2019
BACKGROUND: Glaucoma is a common cause of blindness in the world as well as in Vietnam. It is treated by many different methods but trabeculectomy is still the most popular and highly effective surgical method to treat this condition. AIM: To analyze the status of 5 years filtering blebs following trabeculectomy and to explore multiple factors associated with filtering blebs. METHODS: This is a retrospective, cross-sectional descriptive study. Eyes had been performed trabeculectomy for 5 years were included in these results. The filtering blebs were assessed using slit lamp and OCT. the OCT captured bleb area to evaluate fluid subconjunctival spaces, thickness and height of bleb and to evaluate the related factors RESULTS: A group of 106 primary glaucoma eyes of 97 patients (88 patients with 1 eye, 9 patients 2 eyes) had been performed trabeculectomy for 5 years were taken OCT anterior image. The proportion of female patients is 1.5 times that of male patients. IOP was controlled wi...
Iranian Journal of …, 2011
Purpose: To evaluate usefulness of anterior segment optical coherence tomography (AS-OCT) in evaluation of filtering bleb functionality and to correlate its findings with clinical bleb examination Methods: In this cross-sectional, descriptive study 55 eyes with apparently functional bleb were evaluated. Following a comprehensive ophthalmic examination, filtering bleb grading was performed based on Indiana Bleb Appearance Grading Scale (IBAGS). The bleb was then imaged using AS-OCT. Two radial and tangential scans were obtained. Results: The mean age was 57.69±12.47 years and 29 cases (53%) were female. The mean number of glaucoma medication and intraocular pressure (IOP) were 0.45±0.71 and 14.35±4.67 mmHg, respectively. On AS-OCT examination, the mean bleb height, bleb wall thickness, internal cavity height, posterior extension of the internal cavity were 1.5±0.47 mm, 1±0.4 mm, 0.59±0.28 mm, and 3.15±1.26 mm, respectively. The internal reflectivity was high in 15 cases (27%) and low in 40 cases (73%). There was a positive correlation between the bleb height, bleb wall thickness, and internal cavity height on AS-OCT and IOP. Also, a negative correlation between the posterior extension of the internal cavity and IOP was noted. There was also a positive correlation between the higher IOP and a high internal reflectivity. There has also been a positive correlation between the bleb height at IBAGS and bleb reflectivity at AS-OCT. We also found that there was a positive correlation between the bleb vascularity at IBAGS and internal reflectivity at AS-OCT. Conclusion: AS-OCT seems to be a useful device in evaluation of filtering bleb function. It yields valuable information regarding the internal bleb structures, and its findings are correlated with clinical examination of filtering bleb.
Journal of Glaucoma, 2009
Aim: To determine if imaging of blebs with anterior segment optical coherence tomography (ASOCT) affects clinical decision-making with regard to laser suture lysis (LSL) after trabeculectomy. Method: In this prospective observational case series, we included patients with poorly controlled intraocular pressure (IOP) after standardized trabeculectomy from May to November 2006. One observer assessed IOP, anterior chamber depth and bleb formation, and recorded a decision of whether or not to undertake LSL based on clinical grounds. A second observer masked to clinical data recorded a decision of whether or not to perform LSL based on ASOCT assessment of scleral flap position, presence of a sub-flap space, patency of the internal ostium, and bleb wall thickening. We compared the 2 observers' decisions to determine how ASOCT influenced decision-making. Results: Seven eyes of 7 patients were included. On the basis of clinical examination, LSL was recommended in all 7 (100.0%) cases due to presence of elevated IOP, deep anterior chambers and poorly formed blebs. Using ASOCT, LSL was recommended in 5/7 (71.4%) cases with apposed scleral flaps, absent sub-flap spaces, and absent bleb wall thickening. In 2/7 (28.7%) cases, LSL was not recommended based on ASOCT findings of an elevated scleral flap, a patent sub-flap space, and bleb wall thickening. All 7 patients had good IOP control and formed blebs at a mean of 8.4 ± 2.6 months after trabeculectomy, with a mean IOP of 14.3 ± 3.2 mm Hg with no medications. Conclusions: This small study suggests that ASOCT imaging may affect decision-making with regard to LSL by providing information not apparent on clinical examination.