Precise Identification of Filtration Openings on the Scleral Flap by Three-Dimensional Anterior Segment Optical Coherence Tomography

Inoue, Toshihiro; Matsumura, Riyo; Kuroda, Utako; Nakashima, Kei; Kawaji, Takahiro; Tanihara, Hidenobu

doi:10.1167/iovs.12-10941

Cited by 31 publications

(27 citation statements)

References 18 publications

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“…These results are consistent with our previous finding that the opening locations were similar despite the pattern of remaining sutures and cut nylon sutures. 11 Only fluid cavity height increased significantly after LSL. However, from analyzing only the successful procedures (IOP reduction 425%), the width of the filtration openings on the Figure 2 Representative bleb images assessed by three-dimensional anterior segment optical coherence tomography before (a-e) and after (f-j) successful laser suture lysis (LSL).…”

Section: Discussionmentioning

confidence: 92%

“…11 Briefly, the area examined included the entire scleral flap and bleb. Three reviewers evaluated the complete 3D images of the internal structure of the filtration blebs, and independently assessed filtration openings.…”

Section: Data Collectionmentioning

confidence: 99%

“…Those blebs in which filtration openings could be identified by 3D AS-OCT were termed type F; those blebs in which filtration openings could not be identified were termed as described in our previous study. 11 Briefly, non-functioning flat-shaped blebs without fluid-filled cavity, blebs had an elevated bleb wall that was sometimes of high reflectivity, and blebs of which filtration openings were masked by a sponge-like structure exhibiting low reflectivity were defined as type N, H, and S, respectively. In the type F blebs, the width of the filtration openings on the scleral flap and the distance between the top of the scleral flap and the center of the opening was defined as the top filtration distance (TFD; Figure 1).…”

Section: Data Collectionmentioning

confidence: 99%

“…9,10 In our previous studies we obtained 512 3D scans that were rotated using newly developed software (CASIA bleb-assessment software, Tomey) and matched with reconstructed C-scan images (tomographic image of the slice plane perpendicular to the depth direction) to precisely identify the filtration openings on the scleral flap. [11][12][13][14] Filtration openings were identified in 95% (118 of 124) of the eyes; the location of the openings was also visualized. We found that the pattern of filtration openings was not affected by the residual suture after laser application in this small case series of laser suture lysis (LSL).…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 92%

Section: Data Collectionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…Three -dimensional anterior segment optical coherence tomography (OCT)not only is useful for bleb revision but also provides important information regard the internal morphology of the blebs, the precise identification of filtration openings from margins of the scleral flap which may affect the plan for needling [19].…”

Section: The Futurementioning

confidence: 99%

Needle Revision with Antimetabolites in Bleb Failure

Ghoneim¹

2014

J Clin Res Ophthalmol

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Bleb failure after initially successful glaucoma surgery still constitutes a major challenge in management of glaucoma patients.Needling is considered a simple surgical technique that can solve a major problem like failure of glaucoma surgery.The introduction of antimetabolite in ophthalmology greatly enhances the results of needling as well as the initial trabeculectomy.Mitomycin C(MMC) and 5-Fluorouracil (5FU) used as adjunctive therapy with needling for management of bleb failure with variable success rates but the results with antimetabolites is significantly better than needling alone.In conclusion needling augmented with antimetabolitesis simple technique, relatively safe, fast and has a high success rate, even in complicated glaucoma.

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Filtering Blebs Using 3-Dimensional Anterior-Segment Optical Coherence Tomography

et al. 2015

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IMPORTANCE Posttrabeculectomy changes in bleb parameters measured using 3-dimensional (3-D) anterior-segment optical coherence tomography (OCT) remain uncharacterized and might be related to postsurgical intraocular-pressure (IOP) control. OBJECTIVE To evaluate time-dependent posttrabeculectomy changes in filtering bleb parameters using 3-D anterior-segment OCT. DESIGN, SETTING, AND PARTICIPANTS This prospective observational study was conducted at Kumamoto University Hospital, Kumamoto, Japan. Patients with open-angle glaucoma who underwent uncombined fornix-based trabeculectomy at Kumamoto University Hospital between January 1, 2012, and October 31, 2012, were included. Twenty-nine eyes were enrolled, 23 of which were followed up for 1 year without additional glaucoma surgical procedures; 3 required additional glaucoma surgery. INTERVENTIONS Imaging filtering blebs using 3-D anterior-segment OCT.MAIN OUTCOMES AND MEASURES The primary end points were changes in bleb parameters including the position and width of the filtration openings on the scleral flap, the total bleb height, fluid-filled cavity height, bleb wall thickness, and bleb wall intensity, which were measured using 3-D anterior-segment OCT. The secondary end points were postsurgical IOP measured 0.5, 3, 6, and 12 months after trabeculectomy, and the effects of aqueous cytokine levels on the bleb parameters. RESULTS We observed increased total bleb height (0.82 to 1.25 mm; difference: 95% CI, 0.10 to 0.75; P = .01), bleb wall thickness (0.46 to 0.61 mm; difference: 95% CI, 0.02 to 0.28; P = .03), and distance from the top of the scleral flap to the filtration opening (1.69 to 2.16 mm; difference: 95% CI, 0.28 to 0.70; P < .001), as well as decreased width of the filtration opening (2.08 to 1.12 mm; difference: 95% CI, −1.75 to −0.49; P = .002) between 0.5 and 12 months posttrabeculectomy. The filtration openings tended to close from the fornix side of the scleral flap during the wound healing process. Moreover, the width of the filtration opening at 0.5 months posttrabeculectomy correlated with the IOP at 12 months (P = .02). The aqueous humor level of monocyte chemoattractant protein-1 was correlated with the width of the filtration opening at 3 and 6 months posttrabeculectomy. CONCLUSIONS AND RELEVANCEThe width of the filtration opening at 0.5 months posttrabeculectomy correlated with the IOP at 12 months. The width of the filtration opening at the early stage may be a prognostic factor for long-term IOP control. Large-scale studies with longer follow-up periods are required.

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Precise Identification of Filtration Openings on the Scleral Flap by Three-Dimensional Anterior Segment Optical Coherence Tomography

Abstract: 3D AS-OCT allows, in most cases, detailed evaluation of internal morphology of filtration blebs and precise identification of filtration openings on the scleral flap margins after trabeculectomy.

Cited by 31 publications

References 18 publications

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

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

Needle Revision with Antimetabolites in Bleb Failure

Filtering Blebs Using 3-Dimensional Anterior-Segment Optical Coherence Tomography

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