A Pilot Study of a System for Grading of Drainage Blebs after Glaucoma Surgery

Wells, Anthony P; Crowston, Jonathan G; Marks, J.R.; Kirwan, James; Smith, George Davey; Clarke, Jonathan; Shah, Rakhee; Vieira, José Gilberto H.; Bunce, Catey; Murdoch, Ian; Khaw, PT

doi:10.1097/00061198-200412000-00005

Cited by 159 publications

(140 citation statements)

References 19 publications

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“…A space maintainer (implant) is frequently utilized to enhance the intrascleral lake and to improve long-term success. 9,13 External bleb classifications 10,11 have been described to address the glaucoma surgery functionality and prognosis but they cannot assess the intrascleral bleb. Recently, the AS-OCT has been used to evaluate filtering blebs after trabeculectomy [2][3][4] and DS with collagen scleral implant.…”

Section: Discussionmentioning

confidence: 99%

“…7 The use of the implants or antimetabolites has been advocated to maintain the scleral space, created by the removal of the deep sclerocorneal flap. 8,9 The existing classifications 10,11 for evaluating glaucoma filtering blebs rely mostly on external bleb characteristics and the postoperative control of IOP. As DS has four possible mechanisms of IOP reduction (subconjuctival bleb, intrascleral bleb, suprachoroidal, and episcleral vein outflow of aqueous from Schlemm's canal), 12 DS external bleb appearance could not correlate necessarily with IOP because the intrascleral bleb cannot be seen or evaluated by slit-lamp examination.…”

Section: Introductionmentioning

confidence: 99%

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A comparison of intrascleral bleb height by anterior segment OCT using three different implants in deep sclerectomy

Fernández-Buenaga

Rebolleda

Casas-Llera

et al. 2012

Eye

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Purpose To compare intrascleral blebs characteristics after deep sclerectomy (DS) with three intrascleral implants using the Visante anterior segment optical coherence tomography. Methods This is a cross-sectional study including 60 eyes of 51 patients that underwent DS with Sk-Gel, Esnoper, and Aquaflow implant. Intraocular pressure (IOP) measurement, slit-lamp examination, and Visante scans were performed the same day in all the patients. Visante scans were done through the intrascleral bleb at 451, 901, and 1351 and the bleb height was measured. Results Sk-Gel was used in 19 eyes (31.66%), Esnoper in 22 eyes (36.66%), and Aquaflow in 19 eyes (31.66%). The median time lapsed from the surgery was 15.50 months 25th and 75th percentiles (p 25 8.25; p 75 20). The median IOP was 13 mm Hg (p 25 10; p 75 15), with no significant differences among implants (P ¼ 0.232). Overall, the correlation between the scleral bleb height and the IOP was statistically significant at 451 (r ¼ À0.359; P ¼ 0.004), 901 (r ¼ À0.410; P ¼ 0.001), and 1351 (r ¼ À0.417; P ¼ 0.001). However, Sk-Gel did not show any statistically significant correlation between the scleral height and IOP whereas the other two groups (Esnoper and Aquaflow) showed a significant correlation. There were no differences in the bleb height among implants. Conclusion There was a moderate inverse correlation between the scleral bleb height and the IOP measurement after DS with Esnoper and Aquaflow implants. There were no differences in bleb height among the three implants.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A comparison of intrascleral bleb height by anterior segment OCT using three different implants in deep sclerectomy

Fernández-Buenaga

Rebolleda

Casas-Llera

et al. 2012

Eye

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“…The preoperative maximal area and height of the bleb were graded in anterior segment photographs by two independent observers on magnified pictures by using Moorfields classification. 13 Maximal area values of 0 and 25% received score 0, whereas values of 50% and higher received score 1; height values of 1 (flat) and 4 (encapsulated) received score 0, whereas values of 2 and 3 received score 1; the sum of the values of the maximal area and of the height of the bleb was the final bleb score.…”

Section: Methodsmentioning

confidence: 99%

Long-term effect of phacoemulsification on trabeculectomy function

Longo

Uva

Reibaldí

et al. 2015

Eye

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Purpose To investigate the long-term effect of phacoemulsification on intraocular pressure (IOP) in trabeculectomized eyes and to identify the factors affecting the IOP changes. Methods In consecutive patients with previous trabeculectomy (TE) who underwent uncomplicated clear cornea phacoemulsification we evaluated intraocular pressure, need of antiglaucomatous medical therapy or glaucoma surgery, and length of glaucoma control without therapy. Glaucoma therapy was prescribed in the presence of IOP 418 mm Hg or worsening of the visual field. A group of trabeculectomized eyes that did not receive cataract surgery was retrospectively selected as a control. Multivariate analysis was used to test factors related to final outcome of the treatment. Results One hundred and eight eyes with previous TE that received phacoemulsification and 108 controls were included in the study. Phacoemulsification was performed 60 ± 21 months after TE. After a mean follow-up of 66 ± 28 months, mean IOP was significantly increased in the cataract surgery group (by 1.7 ± 4.3 mm Hg) and in the control group (by 2.3 ± 4.3 mm Hg)(both Po0.001); in two groups, respectively, 31 eyes (28.7%) and 17 eyes (15.7%) had received glaucoma therapy (chi-square P = 0.030). Factors related to success (no need of therapy) were use of mitomycin-C (MMC) in previous TE (Po0.001), longer time from TE to cataract surgery (P = 0.007), higher preoperative bleb score (P = 0.021), and lower baseline IOP (P = 0.042). Conclusions Cataract surgery reduces the function of filtering bleb in some eyes. Factors related to low rate of failure are the previous use of MMC during TE, longer time from TE to cataract surgery, and good preoperative aspect of the bleb.

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“…2,3 Recognizing the importance of bleb appearance in relation to the surgical outcome, several classifications of bleb morphology based on slit-lamp grading have been proposed. 4,5 The visualization of internal bleb structures was first reported using ultrasound biomicroscopy (UBM). 6 However, UBM is limited by the need for contact, especially in the early postoperative period, and the axial resolution does not exceed 25 μm.…”

Section: Introductionmentioning

confidence: 99%

Effect of laser suture lysis on filtration openings: a prospective three-dimensional anterior segment optical coherence tomography study

Cho

Kojima

Inoue

et al. 2015

Eye

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Purpose To investigate the effects of laser suture lysis (LSL) on filtration openings after trabeculectomy. Methods Prospective study analyzing the changes in the location and width of filtration openings, fluid cavity height, total bleb height, bleb wall thickness, and bleb wall intensity before and after LSL using threedimensional anterior segment optical coherence tomography (3D AS-OCT). Results Fourteen patients had clear scleral flap image analysis. As five patients underwent LSL twice and two patients underwent LSL thrice, 23 comparison studies were possible. After LSL the intraocular pressure (IOP) decreased (P = 0.0015) from 20.5 ± 5.3 to 14.9 ± 6.4 mm Hg, and the fluid cavity height increased significantly from 0.2 ± 0.2 mm to 0.3 ± 0.1 mm (P = 0.0094). Other bleb parameters were not significantly different when comparing before and after LSL. When the IOP reduction ratio was 425% following LSL, the width of the filtration openings on the LSL side, the total bleb height, and the fluid cavity height increased (P = 0.0273, 0.0342, and 0.0024, respectively). In multiple regression analysis the changes in fluid cavity height, the wall thickness, the wall intensity, and the width of the filtration opening were positively associated with the IOP reduction rate (P = 0.0428, 0.0226, 0.0420, and 0.0356, respectively). Conclusions 3D AS-OCT allowed a detailed examination of the internal morphology of filtration blebs and openings before and after LSL. The changes in the internal morphology were closely associated with the success of LSL to decrease IOP.

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A Pilot Study of a System for Grading of Drainage Blebs after Glaucoma Surgery

Cited by 159 publications

References 19 publications

A comparison of intrascleral bleb height by anterior segment OCT using three different implants in deep sclerectomy

A comparison of intrascleral bleb height by anterior segment OCT using three different implants in deep sclerectomy

Long-term effect of phacoemulsification on trabeculectomy function

Effect of laser suture lysis on filtration openings: a prospective three-dimensional anterior segment optical coherence tomography study

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