Filtering Bleb Structure Associated with Long-Term Intraocular Pressure Control after Amniotic Membrane-Assisted Trabeculectomy

Nakamura, Makoto; Naka, Maiko; Tatsumi, Yasuko; Nagai-Kusuhara, Azusa; Kanamori, Akira; Yamada, Yuko; Negi, Akira

doi:10.3109/02713683.2011.635403

Cited by 10 publications

(30 citation statements)

References 28 publications

(38 reference statements)

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“…Only one study has reported on intrableb structures after trabeculectomy with AMT [ 18 ]. Nakamura et al [ 18 ] compared the intrableb structure after trabeculectomy between AMT and non-AMT groups using UBM.…”

Section: Discussionmentioning

confidence: 99%

“…The fluid-filled space height was measured as the maximal vertical distance in the signal void or hyporeflective area between the bottom of the inner bleb wall and the top of the sclera along a straight line perpendicular to the tangent of the sclera ( Fig 2 ). The FFSS was graded from 0 to 2 as follows: (1) score 0, no visible fluid-filled space; (2) score 1, limited and demarcated fluid-filled space with a clear posterior margin; and (3) score 2, diffuse fluid-filled space extending posteriorly beyond the view of the image field ( Fig 3 ) [ 18 , 21 ].…”

Section: Methodsmentioning

confidence: 99%

“…Jinza et al [ 17 ] reported that the thickness of the aqueous drainage route under the scleral flap correlated with the development of a filtering bleb. Nakamura et al [ 18 ] evaluated intrableb structures after trabeculectomy with AMT using UBM and reported that the extent of the subconjunctival fluid-filled space was associated with long-term IOP control. However, UBM examination requires considerable effort to obtain high-quality images and contact with the eye, which can cause an infection.…”

Section: Introductionmentioning

confidence: 99%

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Bleb analysis using anterior segment optical coherence tomography after trabeculectomy with amniotic membrane transplantation

et al. 2023

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Introduction Little has been known about the intrableb structures associated with bleb function after trabeculectomy with amniotic membrane transplantation (AMT). The aim of this study is to analyze the characteristics of intrableb structures using anterior segment optical coherence tomography (AS-OCT) after trabeculectomy with AMT. Methods A total of 68 eyes of 68 patients with primary open-angle glaucoma who underwent trabeculectomy with AMT were included. Surgical success was defined as intraocular pressure (IOP) ≤ 18 mmHg and IOP reduction of ≥ 20% without medication on AS-OCT examination. Intrableb parameters, including bleb height, bleb wall thickness, striping layer thickness, bleb wall reflectivity, fluid-filled space score, fluid-filled space height, and microcyst formation were evaluated using AS-OCT. Logistic regression analysis was performed to determine factors associated with IOP control. Results Of the 68 eyes, 56 eyes were assigned to the success group and 12 eyes to the failure group. In the success group, bleb height (P = 0.009), bleb wall thickness (P = 0.001), striping layer thickness (P = 0.001), fluid-filled space score (P = 0.001), and frequency of microcyst formation (P = 0.001) were greater than those in the failure group. Bleb wall reflectivity was higher in the failure group than in the success group (P < 0.001). In the univariate logistic regression analysis, previous cataract surgery was significantly associated with surgical failure (odds ratio = 5.769, P = 0.032). Conclusion A posteriorly extending fluid-filled space, tall bleb with low reflectivity, and thick striping layer were characteristics of successful filtering blebs after trabeculectomy with AMT.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bleb analysis using anterior segment optical coherence tomography after trabeculectomy with amniotic membrane transplantation

et al. 2023

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“…Recently, Nakamura et al 22 also reported about AM-assisted TLE, comparing the intrableb structures of AM-TLE with those of TLE alone using an ultrasound biomicroscope. The findings of that study revealed that the intrableb structures in AM-assisted TLE contained a wide fluid-filled space with a relatively thin wall, whereas those produced during TLE alone had no or minimal fluid-filled space.…”

Section: Discussionmentioning

confidence: 99%

Amniotic membrane-assisted trabeculectomy for refractory glaucoma with corneal disorders

Mori¹,

Ikeda²,

Maruyama³

et al. 2016

IMCRJ

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PurposeTo report the cases of six consecutive patients who underwent amniotic membrane (AM)-assisted trabeculectomy (TLE) to treat refractory glaucoma with severe corneal disorders.MethodsThis study involved six patients (three males and three females, mean age: 69.5±15.8 years) with refractory glaucoma and severe corneal disorders. The surgical procedure for each patient involved trabecular tissue being excised, and human AM then being placed epithelial side up on the corneal surface, sutured at the limbal sclera, and flipped over onto the sclera to cover the TLE area. The remaining edge of the AM was then inserted into the subconjunctival space and sutured. Medical records of all cases were reviewed with regard to intraocular pressure (IOP), visual acuity, and condition of the filtering bleb and ocular surface.ResultsThe mean observation period was 69.5±15.8 months, and mean IOP at presurgery and at 1, 3, and 7 years postoperative was 40.3±6.9, 23.0±12.1, 25.6±12.8, and 28.5±19.1 mmHg, respectively. Glaucoma medications decreased from 3.0±1.1 drugs (presurgery) to 0.8±1.0 drugs (7 years postoperative). However, in some cases, ocular surface conditions or visual acuity worsened during the follow-up period.ConclusionUsing AM as an internal patch for TLE, moderately good IOP control was obtained initially for the refractory glaucoma with severe corneal disorders; however, ocular surface conditions required special care, and the long-term IOP control was limited in some cases.

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“… 43 However, other studies, including two random ized clinical trials, assessing primary trabeculectomy with amniotic membrane vs primary trabeculectomy alone (without the use of MMC or 5FU) for POAG have demons-t rated no sign ifica nt benefit in IOP cont rol at the 1 and 2-year time points. 44 - 46 These differences in reported out comes may partly be due to the different techniques of amniotic membrane placement as well as the use of antimeta bolites. Nevertheless, the evidence base for the use of amniotic membrane in glaucoma filtration surgery currently remains inconclusive.…”

Section: Introductionmentioning

confidence: 99%

Wound Healing Modulation in Glaucoma Filtration Surgery– Conventional Practices and New Perspectives: Antivascular Endothelial Growth Factor and Novel Agents (Part II)

Gaskin

Nguyen

Ang

et al. 2014

Journal of Current Glaucoma Practice

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Glaucoma filtration surgery is regularly performed for the treatment of glaucoma and trabeculectomy is often regarded as the ‘gold standard' glaucoma operation. The biggest risk of failure of the operation is bleb scarring. The advent of antifibrotic agents, such as mitomycin C (MMC) and 5-fluorouracil (5FU) has vastly prolonged the longevity of the bleb, but concerns remain regarding the potential increase in postoperative complications. More selective therapeutic targets have therefore been explored. One of these is vascular endothelial growth factor (VEGF) inhibition. VEGF inhibition has a role not only in subconjunctival angiogenesis inhibition but also it has direct anti-fibrotic properties. Newer pharmacological compounds and materials have also been developed in recent years in attempt to modulate the wound healing in different ways after glaucoma surgery. These include physical barriers to scarring and vehicles for sustained release of pharmacological agents, and early promising results have been demonstrated. This two-part review will provide a discussion of the application of anti-fibrotic agents in glaucoma filtration surgery and evaluate the newer agents that have been developed.How to cite this article: Fan Gaskin JC, Nguyen DQ, Ang GS, O'Connor J, Crowston JG. Wound Healing Modulation in Glau coma Filtration Surgery–Conventional Practices and New Pers pectives: Antivascular Endothelial Growth Factor and Novel Agents (Part II). J Curr Glaucoma Pract 2014;8(2):46-53.

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Filtering Bleb Structure Associated with Long-Term Intraocular Pressure Control after Amniotic Membrane-Assisted Trabeculectomy

Abstract: Intrableb structures after trabeculectomy alone versus AMT-assisted trabeculectomy were distinct. The bleb wall reflectivity in the former and the extent of the subconjunctival fluid-filled space in the latter were factors associated with long-term IOP control.

Cited by 10 publications

References 28 publications

Bleb analysis using anterior segment optical coherence tomography after trabeculectomy with amniotic membrane transplantation

Bleb analysis using anterior segment optical coherence tomography after trabeculectomy with amniotic membrane transplantation

Amniotic membrane-assisted trabeculectomy for refractory glaucoma with corneal disorders

Wound Healing Modulation in Glaucoma Filtration Surgery– Conventional Practices and New Perspectives: Antivascular Endothelial Growth Factor and Novel Agents (Part II)

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