Morphology of functioning trabeculectomy blebs using anterior segment optical coherence tomography.
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Date
2014-06
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Abstract
Purpose: 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.
Description
Keywords
AS‑OCT, bleb morphology, trabeculectomy
Citation
Khamar Mayuri B, Soni Shruti R, Mehta Siddharth V, Srivastava Samaresh, Vasavada Viraj A. Morphology of functioning trabeculectomy blebs using anterior segment optical coherence tomography. Indian Journal of Ophthalmology. 2014 June ; 62 (6): 711-714.