Intraoperative Optical Coherence Tomography-Guided Bleb-sparing Epithelial Exchange: A Modified Approach

Area of Science:

• Ophthalmology
• Surgical Technology
• Medical Imaging

Background:

• Glaucoma surgery often involves creating filtration blebs to manage intraocular pressure.
• Bleb complications can arise, necessitating revision surgery for improved efficacy.
• Advancements in surgical imaging are crucial for enhancing precision in ophthalmic procedures.

Purpose of the Study:

• To introduce and evaluate a novel surgical technique for bleb revision using intraoperative real-time anterior segment optical coherence tomography (OCT).
• To assess the precision, safety, and efficacy of OCT-guided bleb repair in glaucoma surgery.

Main Methods:

• Bleb revision surgery was performed utilizing intraoperative real-time OCT integrated with an OPMI LUMERA 700 operating microscope.
• Live surgical and OCT imaging were displayed simultaneously on a common screen for direct visualization.
• The technique focused on precise localization and maneuvering within the bleb anatomy.

Main Results:

• The OCT-guided bleb revision technique allowed for enhanced visualization of bleb anatomy and tissue depth.
• Both cases demonstrated a moderately elevated, diffuse, and functional bleb three months post-surgery.
• Controlled intraocular pressure was achieved in both patients following the procedure.

Conclusions:

• Intraoperative OCT-guided bleb-sparing epithelial exchange is a valuable adjunctive technique for bleb repair.
• This method increases surgical precision, potentially reducing complications and minimizing surgical time.
• The technique holds promise for maximizing surgical outcomes in bleb revision procedures.