High‐definition imaging of trabeculectomy blebs using spectral domain optical coherence tomography adapted for the anterior segment

Singh, Mandeep S.; See, Jovina; Aquino, Maria Cecilia; Thean, Lennard S Y; Chew, Paul

doi:10.1111/j.1442-9071.2009.02066.x

Cited by 30 publications

(27 citation statements)

References 27 publications

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“…2,4,8,9 AS-OCT has gained favor because it is a method that produces higher resolution compared with UBM. Various morphological studies have been performed using different types of OCT, 2,4,[8][9][10] and SD-OCT is reportedly excellent for viewing the superficial part of the bleb; however, it has limited clinical utility because it does not provide useful information about deep features in blebs. 10 On the other hand, timedomain AS-OCT is an excellent device for the observation of deep structures of the bleb, such as LUSF or CCD, which may be very important to evaluate bleb function.…”

Section: Discussionmentioning

confidence: 99%

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Bleb Analysis by Using Anterior Segment Optical Coherence Tomography in Two Different Methods of Trabeculectomy

Hamanaka

Omata

Sekimoto

et al. 2013

Invest. Ophthalmol. Vis. Sci.

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Citation: Hamanaka T, Omata T, Sekimoto S, Sugiyama T, Fujikoshi Y. Bleb analysis by using anterior segment optical coherence tomography in two different methods of trabeculectomy. Invest Ophthalmol Vis Sci. 2013;54:6536-6541. DOI: 10.1167/iovs.13-12439 PURPOSE. To investigate the correlation between bleb morphology and IOP control via the modified Indiana Bleb Appearance Grading Scale (IBAGS) and anterior-segment optical coherence tomography (AS-OCT) in two different trabeculectomy (TLE) groups.METHODS. This study involved 94 eyes with primary open angle glaucoma that underwent two different TLE methods: limbal-based TLE (group I, 62 eyes) and fornix-based TLE (group II, 32). IOP control was defined as successful with an IOP 20 mm Hg and ‡20% reduction of preoperative IOP. IBAGS and various parameters of the bleb height, extent, wall thickness, ciliochoroidal detachment (CCD), and lake under the scleral flap (LUSF) were obtained by slitlamp and AS-OCT, respectively. Correlation between IOP control and IBAGS/AS-OCT parameters were assessed by SAS.RESULTS. Both groups had the same success rate. As to correlation between IOP control and IBAGS, extent and Seidel were the best-paired parameters in group I (Cp ¼ 3.0402, R ¼ 0.6401), yet no parameter was significant in group II (maximum R ¼ 0.1599). As to correlation between IOP control and AS-OCT, the combinations of height, extent, and the minimum value of bleb wall thickness were significant (Cp ¼ 0.2037, 0.2314, R ¼ 0.4336, 0.4330) in group I. In group II, no parameter was significant, except CCD and/or LUSF (P ¼ 0.032). As to coincidence of IBAGS and AS-OCT parameters, height and extent in group I (P ¼ 0.000, P ¼ 0.000) and height in group II were statistically significant (P ¼ 0.020).CONCLUSIONS. IOP control in limbal-based TLE seemed to be more dependent on the large size and thinned-wall bleb than that in fornix-based TLE.

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Section: Discussionmentioning

confidence: 99%

“…Spectral domain OCT (SD-OCT) reportedly fared poorly compared with AS-OCT in imaging deep structures in blebs, such as the bleb cavity, scleral flap, the subflap space, and internal ostium. 10 Therefore, timedomain AS-OCT may be more useful for assessing bleb function, as it penetrates more deeply into the sclera than does SD-OCT.…”

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confidence: 99%

Bleb Analysis by Using Anterior Segment Optical Coherence Tomography in Two Different Methods of Trabeculectomy

Hamanaka

Omata

Sekimoto

et al. 2013

Invest. Ophthalmol. Vis. Sci.

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“…The presence or absence of bleb wall thickening and of the abovesaid intrableb wall structures, which identified a bleb as successful or failed, was assessed with respect to a r17 mm Hg target IOP level. 28,29 Thereafter, the sensitivity and specificity rates were calculated.…”

Section: Surgical Techniquesmentioning

confidence: 99%

Biodegradable collagen matrix implant vs mitomycin-C as an adjuvant in trabeculectomy: a 24-month, randomized clinical trial

Cillino

Pace

Cillino

et al. 2011

Eye

106

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Aim To verify the safety and efficacy of Ologen (OLO) implant as adjuvant compared with low-dosage mitomycin-C (MMC) in trabeculectomy. Methods This was a prospective randomized clinical trial with a 24-month follow-up. Forty glaucoma patients (40 eyes) were assigned to trabeculectomy with MMC or OLO. Primary outcome includes target IOP at r21, r17, and r15 mm Hg; complete (target IOP without medications), and qualified success (target IOP regardless of medications). Secondary outcomes include bleb evaluation, according to Moorfields Bleb Grading System (MBGS); spectral domain optical coherence tomography (SD-OCT) examination; number of glaucoma medications; and frequency of postoperative adjunctive procedures and complications. Results The mean preoperative IOP was 26.5 ( ± 5.2) in MMC and 27.3 ( ± 6.0) in OLO eyes, without statistical significance. One-day postoperatively, the IOP dropped to 5.2 ( ± 3.5) and 9.2 ( ± 5.5) mm Hg, respectively (P ¼ 0.009). The IOP reduction was significant at end point in all groups (P ¼ 0.01), with a mean IOP of 16.0 (±2.9) and 16.5 (±2.1) mm Hg in MMC and OLO, respectively. The rates and Kaplan-Meier curves did not differ for both complete and qualified success at any target IOP. The bleb height in OLO group was higher than MMC one (Po0.05). SD-OCT analysis of successful/ unsuccessful bleb in patients with or without complete success at IOP r17 mm Hg indicated a sensitivity of 83% and 73% and a specificity of 75% and 67%, respectively, for MMC and OLO groups. No adverse reaction to OLO was noted. Conclusions Our results suggest that OLO implant could be a new, safe, and effective alternative to MMC, with similar long-term success rate.

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“…[20] This limitation was also shown in our study: in any scan we could overcome the scleral flap in depth, getting no information about the presence of hyporeflective spaces under the sclera and the presence of internal ostium and its patency.…”

Section: Discussionmentioning

confidence: 93%

“…[20] Moreover SD-OCT platforms assess both the posterior and anterior pole of the eye (with the cornea/AS modules) and a dedicated software permits a threedimensional assessment of AC structures and conjunctival bleb. [6] This makes SD-OCT suitable to the study of the bleb-wall characteristics, detecting the presence of optically empty cystic spaces and fibrotic processes.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the conjuntival blebs using spectral domain optical coherence tomography after glaucoma surgery

Lombardo

Vercellin

Raimondi

et al. 2016

CSS

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Objective: Analyze the application of the spectral domain optical coherence tomography (SD-OCT), Optovue iVue, on morphofunctional assessment of filtering blebs after different types of glaucoma surgery and point out the correlation between of morphologic features of blebs (bleb-wall thickness, scleral flap profile, and presence of hyporeflective spaces and internal cavity) and intraocular pressure (IOP). Methods: Thirty-eight eyes of thirty-two primarly open angle glaucoma patients, following three different types of glaucoma surgery (trabeculectomy with MMC 0.3%; with the implant of the Ex-PRESS device; with the insertion of Ologen [OLO]) were recruited. Patients attended a 6-month follow-up with intermediate checks at 1 week, 1 month and 3 months. Each visit include the evaluation of bleb using both slit lamp biomicroscopy and OCT. Results: In all patients, regardless of the type of surgery, a very significant reduction of IOP is observed after surgery. The bleb-wall thickness and the scleral flap profile are not shown to be sensitive parameters to identify the functionality of the bleb. The presence of hyporeflective spaces and of a cavity over the sclera is an important sign of bleb functionality. Among the different types of surgery, a higher percentage of blebs provided with hyporeflective spaces is in the Ex-PRESS group. In regards to the presence of a cavity over the sclera, there are no differences between the different groups. Comparing the blebs with filtering aspect at the OCT in the different groups, in the Ex-PRESS group there is a higher percentage of blebs with a filtering aspect compared to the other groups. Conclusions: Optovue iVue, is able to show detailed superficial features of the bleb which significantly correlate with the functionality of the bleb itself.

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High‐definition imaging of trabeculectomy blebs using spectral domain optical coherence tomography adapted for the anterior segment

Abstract: SDOCT imaging was able to show fine superficial features in the bleb wall. However, SDOCT had limited clinical utility in that it did not provide useful information about deep features such as flap position, bleb cavity formation or patency of the subflap space and internal ostium.

Cited by 30 publications

References 27 publications

Bleb Analysis by Using Anterior Segment Optical Coherence Tomography in Two Different Methods of Trabeculectomy

Bleb Analysis by Using Anterior Segment Optical Coherence Tomography in Two Different Methods of Trabeculectomy

Biodegradable collagen matrix implant vs mitomycin-C as an adjuvant in trabeculectomy: a 24-month, randomized clinical trial

Evaluation of the conjuntival blebs using spectral domain optical coherence tomography after glaucoma surgery

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