Comparison of bleb morphology between trabeculectomy and deep sclerectomy using a clinical grading scale and anterior segment optical coherence tomography

Oh, Lawrence; Wong, Eugene; Lam, Julie; Clement, Colin I

doi:10.1111/ceo.12953

Cited by 28 publications

(18 citation statements)

References 31 publications

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“…IBAGS and AS-OCT have been used by Oh et al [ 38 ] to present a comparison of bleb morphology between trabeculectomy and deep sclerectomy. Three months postoperatively, on the clinical grading, their trabeculectomy group had significantly higher, broader, and less vascular blebs than the eyes after deep sclerectomy.…”

Section: Discussionmentioning

confidence: 99%

The CLASS Surgical Site Characteristics in a Clinical Grading Scale and Anterior Segment Optical Coherence Tomography: A One-Year Follow-Up

Jankowska-Szmul

Wylęgała

2018

Journal of Healthcare Engineering

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Purpose We combined a clinical grading scale and swept source anterior segment OCT to describe the successful and failed CLASS. Material and Methods 23 patients in the successful group and 17 patients in the failed group were compared in terms of the IBAGS grades and AS-OCT findings at one, three, and twelve months postoperatively. Results The majority in the successful group presented shallow blebs (91%, 57%, and 52% at 1M, 3M, and 12M, resp.). 59% of the failed group presented no bleb (H0 E0) from the early postoperative period with the rate increasing to 88% at 3M and 100% at 12M. The scleral lake was detected in all the successful patients. The successful group showed significantly higher rates of TDM integrity (P < 0.001), IF (P < 0.001), and SCF (P < 0.05), but there were no significant differences in the rates of microcysts between the groups (P > 0.05). We found a significant decrease in the SL anteroposterior extent (P=0.003) and SL height (P < 0.001) over time, with no significant correlation between the above parameters and IOP. Conclusions The subconjunctival bleb may be a sign of the successful CLASS when it matches the AS-OCT findings of TDM integrity, maintained scleral lake, and intrascleral fluid. A validated OCT pixel intensity measurement is required to evaluate the bleb reflectivity.

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Section: Discussionmentioning

confidence: 99%

The CLASS Surgical Site Characteristics in a Clinical Grading Scale and Anterior Segment Optical Coherence Tomography: A One-Year Follow-Up

Jankowska-Szmul

Wylęgała

2018

Journal of Healthcare Engineering

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“…The primary limitation of WBCS is that it is not always possible to grade microcysts in every part of the filtering bleb solely from photographs, and therefore, some cases might need the help of a slit lamp [28]. Through this pilot observation, we found that the iPhone X images were comparable to slit-lamp photographs for bleb morphology assessment.…”

Section: Discussionmentioning

confidence: 81%

A pilot study for smartphone photography to assess bleb morphology and vasculature post-trabeculectomy

et al. 2020

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Purpose The current grading systems used for bleb morphology assessment in patients post-trabeculectomy are based on standardized slit-lamp photographs and anterior segment imaging devices. The lack of availability of these expensive and non-portable devices in resource-deficient settings is a significant deterrent in their widespread utilization for proper post-operative management. The rapidly evolving utilization of smartphone photography has significantly benefited diagnostics of posterior segment disorders and is now being increasingly utilized for monitoring anterior segment pathologies as well as post-surgical course. In this study, we study a novel use of smartphones for bleb photography for assessing Electronic supplementary material The online version of this article (

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“…With our protocol of management, we performed needle revision with 5-FU rather than administering additional glaucoma medications. In reviewing previous studies, bleb functionality may relate with not only vascularity but also bleb height, bleb wall thickness, etc 22,33. This may explain the insignificant correlation of IOP with vascularity densities (color and brightness densities, vascularity scores of IBAGS and MBGS).…”

Section: Discussionmentioning

confidence: 96%

Evaluation of Functional Filtering Bleb Using Optical Coherence Tomography Angiography

Seo

Kim

Park

et al. 2019

Trans. Vis. Sci. Tech.

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Purpose This study investigated whether filtering blebs can be evaluated using optical coherence tomography angiography (OCT-A) and compared vascularity parameters with conventional bleb grading systems. Methods A total of 92 patients with glaucoma, who underwent mitomycin C–augmented trabeculectomy, were enrolled in this study, and 92 eyes were assessed in total. The participants underwent OCT-A in external mode and anterior segment photography for bleb evaluation. For evaluation of bleb vascularity, a blinded observer carefully drew the bleb area on the original OCT-A image using a semiautomated program that calculated the color and brightness densities of the selected area. A blinded observer also classified the grades of the bleb vessels using the Indiana Bleb Appearance Grading Scale (IBAGS) and Moorfields Bleb Grading System (MBGS). The vascularity parameters using OCT-A were compared with the IBAGS and MBGS results. In addition, the correlation between intraocular pressure (IOP) and the bleb vascularity parameters was assessed. Results Vessel density measured by OCT-A demonstrated excellent inter- and intraobserver reproducibility. The color and brightness densities were positively correlated with the IBAGS and MBGS vascularity scores. There was no difference in accuracy when predicting IOP risk using vascularity scores from the IBAGS and MBGS or when estimating IOP risk using the color and brightness densities on the net reclassification index. Conclusions Bleb evaluation using OCT-A can evaluate vessel vascularity and showed correlation to the IBAGS and MBGS vascularity grading. Translational Relevance Bleb vascularity measurements using OCT-A could potentially provide objective and quantitative vessel parameters for bleb evaluation following trabeculectomy.

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Comparison of bleb morphology between trabeculectomy and deep sclerectomy using a clinical grading scale and anterior segment optical coherence tomography

Cited by 28 publications

References 31 publications

The CLASS Surgical Site Characteristics in a Clinical Grading Scale and Anterior Segment Optical Coherence Tomography: A One-Year Follow-Up

The CLASS Surgical Site Characteristics in a Clinical Grading Scale and Anterior Segment Optical Coherence Tomography: A One-Year Follow-Up

A pilot study for smartphone photography to assess bleb morphology and vasculature post-trabeculectomy

Evaluation of Functional Filtering Bleb Using Optical Coherence Tomography Angiography

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