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Morphology of functioning trabeculectomy blebs using anterior segment optical coherence tomography.

Mayuri B Khamar1, Shruti R Soni, Siddharth V Mehta

  • 1Glaucoma Centre, Raghudeep Eye Hospital, Ahmedabad, India.

Indian Journal of Ophthalmology
|July 10, 2014
PubMed
Summary

Anterior segment optical coherence tomography (AS-OCT) can predict trabeculectomy bleb success. Early multiform bleb wall reflectivity with microcysts indicates a higher chance of successful bleb function at six months.

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Area of Science:

  • Ophthalmology
  • Surgical Innovation
  • Glaucoma Management

Background:

  • Trabeculectomy is a common glaucoma surgery.
  • Assessing bleb function post-surgery is crucial for patient outcomes.
  • Anterior segment optical coherence tomography (AS-OCT) offers detailed imaging of ocular structures.

Purpose of the Study:

  • To image trabeculectomy blebs using AS-OCT.
  • To correlate early postoperative bleb morphology with long-term bleb function.

Main Methods:

  • Prospective observational study of 56 eyes undergoing trabeculectomy with mitomycin-C (MMC).
  • AS-OCT imaging performed at one and six months postoperatively.
  • Bleb morphology (wall reflectivity, drainage route, internal features) assessed and correlated with intraocular pressure (IOP) at six months.

Main Results:

  • Successful bleb function (IOP <18 mmHg) achieved in 81.5% of eyes at six months.
  • One month postoperatively, 89% of blebs showed multiform wall reflectivity.
  • Multiform bleb wall reflectivity with multiple internal layers and microcysts at one month significantly correlated with successful bleb function at six months (P < 0.001).

Conclusions:

  • AS-OCT can identify early morphological features predictive of trabeculectomy bleb success.
  • Multiform bleb wall reflectivity with specific microcyst patterns is a positive prognostic indicator for bleb function.