BLEB Grading (original) (raw)

How red is a white eye? Clinical grading of normal conjunctival hyperaemia

Eye, 2006

Purpose To quantify the level of normal bulbar conjunctival hyperaemia using the Cornea and Contact Lens Research Unit (CCLRU) grading scale, and to investigate inter-observer agreement. Methods Bulbar conjunctival hyperaemia was assessed by two trained observers, using the CCLRU grading scale (zero to four units) interpolated into 0.1 increments, on the right eye of 121 healthy, non-contact lens-wearing subjects (male ¼ 58, female ¼ 63, median age ¼ 28 years, range 16-77). The eye was observed using a slit-lamp bio-microscope ( Â 10 magnification) under diffuse, white illumination. The subject's position of gaze was directed to allow grading of four quadrants: superior, nasal, inferior, and temporal conjunctiva. Bulbar redness was defined as the average of those four grades of conjunctival hyperaemia. A further twenty subjects were recruited to assess interobserver agreement (male ¼ 8, female ¼ 12, median age ¼ 23 years). Results The average bulbar redness was 1.93 (70.32 SD) units. The nasal (2.370.4) and temporal (2.170.4) quadrants were significantly redder than the superior (1.670.4) and inferior (1.770.4) quadrants (Po0.0001). Males had redder eyes than females by 0.2 units. Inter-observer 95% limits of agreement for bulbar redness was 0.38 units. Conclusions The average bulbar redness of 1.9 units was higher than expected, reflecting the design of the grading scale. A bulbar redness of greater than 2.6 units may be considered abnormal, and a change in bulbar redness of Z0.4 units may be significant.

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.

Defining the Optimal Region of Interest for Hyperemia Grading in the Bulbar Conjunctiva

Computational and Mathematical Methods in Medicine, 2016

Conjunctival hyperemia or conjunctival redness is a symptom that can be associated with a broad group of ocular diseases. Its levels of severity are represented by standard photographic charts that are visually compared with the patient’s eye. This way, the hyperemia diagnosis becomes a nonrepeatable task that depends on the experience of the grader. To solve this problem, we have proposed a computer-aided methodology that comprises three main stages: the segmentation of the conjunctiva, the extraction of features in this region based on colour and the presence of blood vessels, and, finally, the transformation of these features into grading scale values by means of regression techniques. However, the conjunctival segmentation can be slightly inaccurate mainly due to illumination issues. In this work, we analyse the relevance of different features with respect to their location within the conjunctiva in order to delimit a reliable region of interest for the grading. The results show...

Subconjunctival Hemorrhage and Conjunctivochalasis

Ophthalmology, 2009

Subconjunctival hemorrhage (SCH) is a relatively common disease, but there have been no reports concerning the relationship between SCH and conjunctivochalasis (CCh). We compared the grade of CCh between patients with SCH and control patients. Design: Prospective, nonrandomized study. Participants: A total of 104 patients with SCH aged 41 to 94 years and 120 age-and gender-matched controls aged 41 to 94 years were enrolled. Methods: The conjunctiva was divided into the following 8 equal areas: superior, superior/nasal, nasal, inferior/nasal, inferior, inferior/temporal, temporal, and superior/temporal. The age, gender, medical history, ocular history, site of hemorrhage, grade of CCh at 3 locations (nasal, middle, and temporal), and other parameters of CCh were determined in all subjects. Main Outcome Measures: Grade of each CCh parameter and location of SCH. Results: The mean grade of CCh was higher in patients with SCH than in control patients at the nasal (PϽ0.00001), middle (PϽ0.00001), and temporal areas (PϽ0.00001). The downward gaze-or digital pressuredependent changes of CCh and the frequency of superficial punctate keratitis were all increased in SCH patients compared with control patients (PϽ0.00001, PϽ0.00001, and P ϭ 0.00106, respectively). The number of areas involved by SCH and the presence of SCH in each area were positively correlated with the grade of each CCh-related parameter (PϽ0.05). Conclusions: This was the first assessment of the grade of CCh in a large series of consecutive patients with SCH. Our results strongly suggest that CCh may have an important role in the pathogenesis of SCH.

The Ophthalmology Examinations Review

Wong, Tien Yin. p. ; cm. The ophthalmology examinations review /by Tien Yin Wong. Includes index. ISBN 9810243995 (alk. paper) --ISBN 9810244002 (pbk. : alk. paper) 1. Ophthalmology--Outlines, syllabi, etc. 2. Ophthalmology--Examinations, questions,

Comparison of Two Clinical Bleb Grading Systems

Ophthalmology, 2006

To evaluate 2 recently described grading systems for clinical grading of filtering surgery blebs: the Moorfields Bleb Grading System (MBGS) and the Indiana Bleb Appearance Grading Scale (IBAGS). Design: Observational comparative study. Participants: Twenty-four glaucoma filtering blebs in 24 eyes of 17 patients. Methods: Three observers in a prospective agreement study compared MBGS with IBAGS during slit-lamp examination. Main Outcome Measures: Comparison analyses were performed, including agreement, repeatability, and intraclass correlation coefficient (ICC). Results: A wide range of bleb characteristics was represented in the cohort. Acceptable levels of intrasystem agreement were found in both systems: for IBAGS, overall agreement at the 0.5-and 1.0-unit levels were 80.6% and 97.6%, respectively, and for MBGS, these were 78.4% and 97.4% for morphologic and vascularity indices. Repeatability coefficients ranged from 0.5 to 1.4 for MBGS and 0.8 to 1.2 for IBAGS. The ICC values in the MBGS ranged from 0.18 to 0.72 for single measures and 0.39 to 0.88 for average measures. For IBAGS, the single-measure ICC values were between 0.06 and 0.53, and the average-measure ICC values were between 0.16 and 0.77. The MBGS ICC values for bleb size were higher than for IBAGS. Conclusions: Both methods are reproducible clinically and had generally high levels of interobserver agreement. Both have minor deficiencies that should be amenable to improvement. The MBGS performed similarly to the IBAGS for reproducibility, had higher ICC values for morphologic features, and captured extra vascularity data with probable clinical implications.

Clinical Grading of the Upper Palpebral Conjunctiva of Non-Contact Lens Wearers

Optometry and Vision Science, 2001

Purpose: To categorize the appearance of the normal upper palpebral conjunctiva using a grading scale and to investigate interobserver agreement with a grading scale modified to include decimal increments. Methods: Upper palpebral conjunctival appearance of 96 non-contact lens wearing subjects aged 18 to 75 years was assessed using a photographic grading scale that has a generic (zero to four) scale to score redness and roughness of the palpebral conjunctiva. Results: Median redness and roughness was about 1.25 units. About 5% of subjects had redness or roughness >2.0 units. Interobserver agreement improved during the study. By the end of the study, the standard deviation of the discrepancy scores was 0.12 to 0.19 units. Conclusions: Upper palpebral conjunctival redness or roughness >2.0 units are unusual. The grading scale can be used successfully with decimal rather than integer scale increments. For experienced clinicians, a change in grade of >0.5 units may be significant. (Optom Vis Sci 2001;78: 13-18)

Delta Journal of Ophthalmology

The purpose of this study was to evaluate the changes in subfoveal choroidal thickness (SFCT) in eyes with diabetic macular edema (DME) after intravitreal bevacizumab (IVB) injection. Patients and methods Thirty eyes diagnosed as nonproliferative diabetic retinopathy with DME were included in this prospective study. All eyes received an intravitreal injection of 1.25 mg/0.05 ml bevacizumab. Best-corrected visual acuity, SFCT, and central macular thickness were measured and recorded before the IVB injection and 1 month after the injection. The choroidal thickness was measured using enhanced depth imaging technique of Heidelberg Spectralis-optical coherence tomography.