Stratus optical coherence tomography study of filtering blebs after primary trabeculectomy with a fornix-based conjunctival flap.
ABSTRACT To investigate the relationship between filtering bleb function and Stratus optical coherence tomography (OCT) images.
We studied 72 eyes of 65 consecutive patients who had a fornix-based conjunctival flap in primary trabeculectomy with mitomycin C (MMC). Filtering blebs with various types of glaucoma were examined using Stratus OCT. Success rates were defined as intraocular pressure (IOP) < or = 15 mmHg and IOP reduction > or = 25% without medication or additional surgery. Success rates among classified groups were compared using Kaplan-Meier survival curves and the log-rank test.
Blebs were classified into three different categories on the basis of the following Stratus OCT patterns: cystoid type (multiple cysts inside the bleb; 17 eyes), diffuse type (low to high reflective areas that were mixed inside the bleb; 31 eyes) and layer type (medium to high reflective layer inside the bleb; 24 eyes). Success rates in the cystoid-, diffuse- and layer-type blebs were 94%, 97% and 75% (P = 0.02), respectively.
In trabeculectomy with MMC and a fornix-based conjunctival flap, there is a significant association between the success rates and the postoperative Stratus OCT findings of filtering blebs.
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ABSTRACT: To correlate the cross-sectional features of filtering blebs on anterior-segment optical coherence tomography (AS-OCT) 2 weeks after trabeculectomy with bleb function at 6 months. Forty-eight eyes followed for 6 months or more after trabeculectomy with mitomycin C were included. Bleb wall reflectivity of developing blebs on AS-OCT 2 weeks postoperatively was correlated with mature bleb function at 6-month postoperative visit. Developing bleb walls at 2 weeks were classified as uniform in 10/48 eyes (20.8%) and multiform in 38/48 eyes (79.2%). Blebs with uniform reflectivity were significantly more likely to have worse function at 6 months (P < 0.001). Multiform bleb walls had hyporeflective areas seeming to represent loosely-arranged connective tissue (multiple-layer structures), subconjunctival separation, and microcysts. Blebs with multiple-layer structures at 2 weeks were associated with better bleb function at 6 months (P = 0.025). Intraocular pressure (IOP) of developing blebs at 2 weeks did not correlate with bleb function at 6 months (P = 0.471). Bleb wall reflectivity on AS-OCT 2 weeks after surgery may predict bleb function at 6 months, whereas IOP of developing blebs may not.Albrecht von Graæes Archiv für Ophthalmologie 03/2010; 248(8):1173-82. · 1.93 Impact Factor
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ABSTRACT: Evaluation of patients after trabeculectomy can be aided by the use of anterior segment imaging. Two commonly used forms of imaging are ultrasound biomicroscopy (UBM) and optical coherence tomography (OCT). Both modalities can be used to assess bleb morphology and how it affects treatment outcome, measure anterior chamber biometry, identify the presence of supraciliochoroidal fluid, cyclodialysis clefts and malignant glaucoma, and evaluate treatment modalities after trabeculectomy such as in laser suture lysis and needling. OCT, with its finer resolution, is able to view the bleb wall anatomy in detail and because of its non-contact nature can examine the eye sooner after trabeculectomy. UBM, on the other hand, is superior for the visualization of deeper structures such as the ciliary body and posterior chamber essential to identify malignant glaucoma.Seminars in ophthalmology 09/2012; 27(5-6):160-4. · 1.09 Impact Factor
- Acta ophthalmologica 07/2009; 88(2):e50-1. · 2.44 Impact Factor