Early trabeculectomy bleb walls on anterior-segment optical coherence tomography

Nakano, Nobuhiko; Hangai, Masanori; Nakanishi, Hideo; Inoue, Ryo; Unoki, Noriyuki; Hirose, Fuyuki; Ojima, T.; Yoshimura, Nagahisa

doi:10.1007/s00417-010-1311-3

Cited by 53 publications

(63 citation statements)

References 28 publications

(76 reference statements)

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“…Also, low intrableb reflectivity, episcleral fluid, and microcysts were identified in the images of the mature bleb and shown to be related with bleb function and IOP [16,[18][19][20]. Many reports support the notion that AS-OCT is useful in identifying intrableb morphology, and intrableb morphology was shown to be an important aspect in predicting bleb function [21].…”

Section: Discussionmentioning

confidence: 90%

“…Some internal features of the filtering bleb, such as formation of a cavernous fluidfilled space and intrableb reflectivity, have been characterized by ultrasound biomicroscopy (UBM) or anterior segment optical coherence tomography (AS-OCT), and these intrableb features are thought to be related to bleb function [9][10][11]. However, visualization of the internal morphologic changes of trabeculectomy blebs 12 months after ocular compression surgery has not been performed prospectively.…”

Section: Introductionmentioning

confidence: 97%

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Imaging of trabeculectomy blebs with Visante anterior segment optical coherence tomography after digital ocular compression

Ahn

2011

Jpn J Ophthalmol

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 97%

Imaging of trabeculectomy blebs with Visante anterior segment optical coherence tomography after digital ocular compression

Ahn

2011

Jpn J Ophthalmol

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“…This technique is therefore very useful for the follow-up of glaucoma surgery, offering numerous criteria for evaluating bleb functioning, like length and height of the internal fluid-filled cavity, maximum and minimum bleb wall thickness, total bleb height, volumes of the internal fluid-filled cavity and hyporeflective area, and number of microcysts [53,54]. Nakano et al [55] even found that heterogeneity of bleb walls 2 weeks after surgery might predict the outcome of trabeculectomy at 6 months. …”

Section: Postoperative Evaluation Of the Blebmentioning

confidence: 97%

Ocular Surface and External Filtration Surgery: Mutual Relationships

Baudouin¹

2012

Developments in Ophthalmology

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There is a large body of evidence from clinical and experimental studies that the long-term use of topical drugs may induce ocular surface changes, causing ocular discomfort, dry eye, conjunctival inflammation, subconjunctival fibrosis, corneal surface impairment, and, as a consequence of chronic ocular surface changes, the potential risk of failure for further glaucoma surgery. Subclinical inflammation has also been widely described in patients receiving antiglaucoma treatments for long periods of time, with inflammatory cell infiltration and fibroblast activation in the conjunctiva and subconjunctival space. The preservative, especially benzalkonium chloride, which has consistently demonstrated its toxic effects in laboratory, experimental, and clinical studies, could induce or enhance such inflammatory changes. As a quaternary ammonium, this compound causes tear film instability, loss of goblet cells, conjunctival squamous metaplasia and apoptosis, disruption of the corneal epithelium barrier, corneal nerve impairment, chronic inflammation and potential damage to deeper ocular tissues. Drug-induced adverse effects are therefore far from being restricted to only allergic reactions, but they are often very difficult to identify because they mostly occur in a delayed or poorly specific manner, and result from complex and multifactorial interactions between the drugs and the ocular surface. Postoperatively, the ocular surface also plays an important role, as the conjunctiva interacts with aqueous humor and subconjunctival fibrosis may block aqueous outflow and cause surgical failure. As preoperative inflammation underlies postoperative fibrosis and therefore surgical outcome, a better knowledge of ocular surface changes with appropriate evaluation and management should thus become a new paradigm in glaucoma care over the long term.

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“…Yet, it also depends highly on the persistence of filtration efficiency at the bleb site. Therefore, postoperative observation and care of developing filtering bleb in clinical practice is an important tool in reaching the target pressure after filtration surgery in higher percentage of the patients [1].Bleb function is believed to depend on the degree of bleb fibrosis and obstruction of intrascleral aqueous humor flow [3]. Bleb appearance has been assessed using slit-lamp bio microscopy, gonioscopy, Ultrasound Bio Microscopy (UBM) and Optical Coherence Tomography (OCT).…”

mentioning

confidence: 99%

“…Bleb function is believed to depend on the degree of bleb fibrosis and obstruction of intrascleral aqueous humor flow [3]. Bleb appearance has been assessed using slit-lamp bio microscopy, gonioscopy, Ultrasound Bio Microscopy (UBM) and Optical Coherence Tomography (OCT).…”

mentioning

confidence: 99%

UBM - A Tracker for Trabeculectomy

Thatte¹

2017

OCR

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Trabeculectomy is the most popular form of glaucoma filtration surgery and remains the "gold standard" for surgical reduction of Intraocular Pressure (IOP) in uncontrolled glaucoma [1]. It has a success rate of 67% to 94% [2].This partial-thickness filtration operation reduces intra ocular pressure via the creation of a limbal fistula through which aqueous humor drains into the subconjunctival space, establishing a filtering bleb. Long-term success depends on preoperative and intraoperative conditions. Yet, it also depends highly on the persistence of filtration efficiency at the bleb site. Therefore, postoperative observation and care of developing filtering bleb in clinical practice is an important tool in reaching the target pressure after filtration surgery in higher percentage of the patients [1].Bleb function is believed to depend on the degree of bleb fibrosis and obstruction of intrascleral aqueous humor flow [3]. Bleb appearance has been assessed using slit-lamp bio microscopy, gonioscopy, Ultrasound Bio Microscopy (UBM) and Optical Coherence Tomography (OCT). Examining bleb morphology for indications of fibrosis or blockage of fluid flow should be useful in evaluating bleb function.Slit-lamp bio microscopy only illustrates bleb morphology and not the bleb's internal structures. Gonioscopy helps in assessing the internal window and the peripheral iridectomy anatomical position and shape. Cross-sectional imaging modalities such as UBM and Anterior Segment Optical Coherence Tomography (AS-OCT) can depict internal structure of blebs. This therefore, provides information about the structure and possible functionality of filtering blebs [4], complimentary to that obtained by slit-lamp bio microscopy and gonioscopy.Imaging technique AS-OCT, is useful in the evaluation of the iridocorneal angle and post trabeculectomy blebs. It is faster than UBM and eliminates the need for a water bath and eyecup in contact with the globe, therefore is a more comfortable procedure for the patient. However, it has limitations of inability to evaluate any aetiology behind the iris. Impression cytology and In vivo confocal microscopy, alone and together, are also new methods to evaluate the bleb but there are many limitations to its extent of evaluation. Incidentally, there has been limited work undertaken in it. The vascular assessment of the bleb using indocyanine green is a new method to assess the bleb, yet it is also not used because of its invasive nature and limited amount of research work in it [4,5]. Therefore, in this case series only UBM was taken into consideration to observe efficacy in monitoring bleb functions as also to record its capability in non-functioning of bleb to establish probable cause of its failure.Charles Pavlin and Stuart Foster [5][6][7] developed UBM at the Princess Margaret Hospital at Toronto, Canada in 1989. UBM is a high frequency (50MHz) ultrasound technology using water bath that permits non-invasive in vivo imaging of the structural details of the anterior ocular segment at near microscopic...

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Early trabeculectomy bleb walls on anterior-segment optical coherence tomography

Abstract: Bleb wall reflectivity on AS-OCT 2 weeks after surgery may predict bleb function at 6 months, whereas IOP of developing blebs may not.

Cited by 53 publications

References 28 publications

Imaging of trabeculectomy blebs with Visante anterior segment optical coherence tomography after digital ocular compression

Imaging of trabeculectomy blebs with Visante anterior segment optical coherence tomography after digital ocular compression

Ocular Surface and External Filtration Surgery: Mutual Relationships

UBM - A Tracker for Trabeculectomy

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