Architectural analysis of post trabeculectomy blebs using spectral domain optical coherence tomography

Poster Details

First Author: S.Goel INDIA

Co Author(s):    C. Sitaraman   N. Barua           

Abstract Details

Purpose:

Slit lamp examination and IOP monitoring have been used as surrogate marker for assessment of bleb functionality for ages. In general, bleb appearance can be classified clinically as diffuse, cystic, encapsulated and flattened. Good intraocular pressure (IOP) control (>21 mm Hg) after filtration surgery was commonly found to be associated with low lying diffuse blebs. OCT is now being used to look for the internal morphology to predict the long term functional viability of the bleb. A prospective and descriptive study analyzing 60 eyes that had earlier undergone trabeculectomy was performed. All blebs were imaged postoperatively with a spectral domain OCT, (RTVue Inc., Fremont, CA). The architecture was described and functional correlation were evaluation

Setting:

A prospective study done at Anand eye Hospital, Jaipur, rajasthan, India

Methods:

Bleb assessment of all patients operated for only trabeculectomy or combined procedure were done by Slit lamp biomicroscopy and spectral domain OCT. the time span was between 1st post operative day to 1 year. Any patient with Resurgery, previous conjunctival disease or systemic antimetabolite therapy were excluded.

Results:

Of the 30 participants, 20 (66.66%) were males and 10 (33.3%) were females . age group 12-62y. Ten eyes (33.3%) had primary open-angle glaucoma, 10 eyes (33.3.0%) had angle closure glaucoma, 3 eyes (.1%) had exfoliation glaucoma, 2 eyes (.06%%) glaucoma secondary to uveitis, 3 eyes (.1%) had neovascular glaucoma and 2 eyes (.06%%) had developmental glaucoma. All procedure were fornix based. The mean IOP was 12.1±5.4mm Hg. The interval between surgery were 1 day-12 months post operative day. The IOP were significantly correlated with the bleb height 650 microns (range 468-1235), wall thickness 125 microns (range 97-257), internal cavity height 847 microns (range 568-1380) . The mean preoperative IOP of the 20 eyes was 28 mmHg (range 18-36 mmHg) and the final average postoperative IOP at the time of RT OCT-measurement was 12.1 mmHg (range 5-30 mmHg). Internal cavity parameters and bleb reflectivity correlated well with the IOP of a functional bleb. .

Conclusions:

The in vivo architecture of filtering blebs can be objectively described using OCT according to quantitative and qualitative parameters. Internal cavity height and extent, as well as bleb reflectivity measurements are related to the functional aspect of a filtering bleb. FINANCIAL DISCLOSURE?: No