Prospective study of filtering blebs after XEN45 surgery

Area of Science:

• Ophthalmology
• Surgical Innovation
• Medical Imaging

Background:

• Glaucoma and cataracts often require surgical intervention to manage intraocular pressure (IOP) and improve vision.
• Phacoemulsification with XEN45 implantation (PHACO-XEN) is a surgical technique used for combined cataract and glaucoma treatment.
• Filtering blebs are crucial for IOP reduction after glaucoma surgery, and their morphology impacts success.

Purpose of the Study:

• To qualitatively analyze the evolution and morphology of filtering blebs following PHACO-XEN surgery.
• To assess the correlation between bleb characteristics observed via AS-OCT and surgical functionality.
• To determine if AS-OCT can predict the long-term success of XEN-based glaucoma surgery.

Main Methods:

• A prospective study involving 30 eyes undergoing PHACO-XEN surgery.
• Anterior segment optical coherence tomography (AS-OCT) was utilized to examine bleb morphology and reflectivity at 3, 6, and 12 months post-surgery.
• Surgical success was defined by achieving an intraocular pressure (IOP) of ≤18mmHg without antihypertensive medication.

Main Results:

• 90% of filtering blebs were functional, with morphologies categorized as cystic (5/27), diffuse (2/27), and layered (20/27).
• Functional blebs demonstrated varying mean IOPs across morphological types and time points, generally remaining below 18mmHg.
• A higher percentage of blebs exhibited high reflectivity over time (48.15% at 3 months to 77.78% at 12 months), correlating with specific IOP levels.

Conclusions:

• AS-OCT is a valuable tool for predicting filtering bleb functionality after PHACO-XEN surgery.
• Cystic bleb patterns and low reflectivity appear to be associated with better post-operative success.
• Further long-term investigations are warranted to fully elucidate the predictive capabilities of AS-OCT in XEN surgeries.