Appraisal of Bleb Using Trio of Intraocular Pressure, Morphology on Slit Lamp, and Gonioscopy (original) (raw)
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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...
BMC Ophthalmology, 2012
Background To determine the agreement between intraocular pressure and the ‘Wuerzburg bleb classification score’, as well as between single items of the score and intraocular pressure. Interobserver variability was analyzed. Methods 57 post-trabeculectomy eyes were included. Colour photographs were used to score the filtering bleb in accordance to the Wuerzburg bleb classification score by two different examiners. At the same visit, clinical data such as intraocular pressure, best corrected visual acuity, slit lamp biomicroscopy and medical history were obtained by another examiner. Results After trabeculectomy, 42 out of 57 eyes (73.7%) reached the target pressure (≤21mmHg, and intraocular pressure reduction of at least 20%, without antiglaucoma medication, and without any additional intervention). Fair agreement was found between intraocular pressure and Wuerzburg bleb classification score ≥8 points and ≥7 points (kappa 0.24 and 0.27, respectively). Analyzing the subgroups of the ...
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...
Introduction Trabeculectomy has been the standard surgical treatment for glaucoma since its introduction in the 1960s [1]. Studies on outcomes of glaucoma surgery have frequently reported intraocular pressure (IOP) control and complications, less frequently visual outcomes, and have rarely reported bleb morphology in detail [2]. The bleb is the functional part of trabeculectomy and the part that largely determines long-term success, failure, and complications [2]. The early bleb grading systems were proposed by Kronfeld [3], Grehn et al. [4], Vesti [5], and Lederer [6]. These have now been replaced by more representative bleb grading systems such as the Indiana Bleb Appearance Grading Scale (IBAGS) [7] and the Moorfields Bleb Grading System (MBGS) [2]. However, these systems rely on the clinical external appearance of the bleb to predict the bleb functional outcome and are also considered subjective methods; the bleb internal structure can be a more sensitive predictor to the outcom...
Early bleb leak after trabeculectomy and prognosis for bleb failure
Eye, 2009
Aim To determine whether early bleb leak after MMC trabeculectomy affects intermediate intraocular pressure (IOP) outcome. Methods Retrospective case note review. All cases of MMC trabeculectomy with at least 1-year follow-up were included. Cases where a bleb leak occurred within the first month were identified. All cases without an early bleb leak formed the control group. Patient demographics and clinical factors were analysed to determine any factors predisposing to bleb leakage. IOPs were compared for 1 year postoperatively and final follow-up. Results A total of 119 trabeculectomies were included. Of these 27 (22.7%) had an early bleb leak. The remaining 92 cases formed the control group. Mean age of cases was 70.7 years. Mean follow-up time was 19.5 months. Mean time of detection of the bleb leak was 9 days (range 1-21 days). Four cases (14.8%) were managed by primary resuturing. Thirteen cases (48.1%) were managed conservatively with a bandage contact lens. Ten cases (37.0%) resolved with expectant management. There was no statistically significant difference between the two groups with regards to IOP measurement at any time point. Intervention rates were similar with regards to bleb massage, 5-fluorouracil injection, and needling revision. No factors were identified between the two groups that predisposed to bleb leaks occurring. Conclusion Our data suggest that early bleb leak is not a poor prognostic indicator for intermediate bleb survival and IOP control in patients undergoing MMC trabeculectomy. No additional bleb manipulations compared with the control group were required to achieve a satisfactory IOP outcome.
Imaging of Trabeculectomy Blebs Using Anterior Segment Optical Coherence Tomography
Ophthalmology, 2007
Objective: To image trabeculectomy blebs using anterior segment optical coherence tomography (AS-OCT). Design: Prospective cross-sectional study. Participants: Fifty-five patients who had previously undergone trabeculectomy surgery. Methods: All blebs were imaged with a prototype of the AS-OCT. Standardized color monophotographs of blebs were also obtained. Blebs were assessed for the following qualitative features: bleb height, thickness of the conjunctiva in the bleb wall, presence of cystic spaces within the bleb wall, apposition of the scleral flap to underlying sclera, and patency of the internal ostium.
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.
Frequency of bleb manipulations after trabeculectomy surgery
British Journal of Ophthalmology, 2007
Aim: To quantify the type and frequency of postoperative bleb manipulations undertaken after modern glaucoma surgery. Methods: Bleb manipulations were recorded after trabeculectomy surgery on 119 consecutive patients with at least 1 year of follow-up. The type of intervention and time after surgery were recorded. Statistical analysis identified success rates at various intraocular pressure (IOP) cut-off definitions and identified factors that increased the risk for bleb manipulation. Results: In all, 78.2% of trabeculectomies were followed by some form of bleb manipulation. Almost 49% of blebs underwent massage and a similar number required at least one suture removal, 31.1% required at least one 5-fluorouracil (5-FU) injection and 25.2% required at least one needling and 5-FU injection. The median time to the first intervention for massage, suture removal, 5-FU injection, and needling and 5-FU injection were 1, 14, 14 and 43 days, respectively. IOP measurements were higher at all follow-up time points in the intervention group. Failure to achieve specific IOP target pressures was also generally poorer in the 5-FU, and needling and 5-FU intervention groups. Conclusions: Postoperative intervention is a frequent occurrence after modern glaucoma surgery. This requires intensive postoperative follow-up and is a labour-intensive undertaking. Despite interventions in our group of patients, IOP in the intervention group was always higher than in the group that required no intervention.
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.