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J Glaucoma. 2016 May;25(5):e550-8. doi: 10.1097/IJG.0000000000000319.

Evaluation of Blebs After Filtering Surgery With En-Face Anterior-Segment Optical Coherence Tomography: A Pilot Study.

Author information

1
*Department of Ophthalmology, Quinze-Vingts National Ophthalmology Hospital †Center for Clinical Investigations INSERM 503, Quinze-Vingts National Eye Center ‡INSERM, U968 §UPMC Univ Paris 06, UMR_S 968, Institut de la Vision ∥CNRS, UMR_7210, Paris ¶Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt #University of Versailles Saint-Quentin-en-Yvelines, Versailles, France.

Abstract

PURPOSE:

To compare characteristics of functioning blebs (FBs) and nonfunctioning blebs (NFBs) with en-face spectral-domain optical coherence tomography (OCT).

METHODS:

We evaluated 41 blebs of 38 patients after a first-time trabeculectomy. Eyes were classified into 2 groups: FBs (22 eyes) and NFBs (19 eyes). En-face OCT images were analyzed semiquantitatively for the density of intraepithelial microcysts (0 to 3), internal fluid-filled cavity (0 to 3), and bleb vascularization (0 to 2). Presence of conjunctival fibrosis and visualization of the scleral flap were also analyzed.

RESULTS:

FBs showed significantly more intraepithelial microcysts than did NFBs: the mean grading of microcyst density was 1.86 for FBs and 0.11 for NFBs (P<0.0001). None of the FBs were rated 0 and none of the NFBs were rated 2 or 3 for the density of intraepithelial microcysts. NFBs presented more conjunctival fibrosis than FBs (63% vs. 32%, P<0.05). There was no significant difference between FBs and NFBs for bleb vascularization, visualization of the scleral flap, and presence of subepithelial fluid-filled cavities. There was a direct correlation between postoperative intraocular pressure and intraepithelial microcyst density (r=-0.7655, P<0.0001). The long-term administration of preserved eyedrops before surgery was associated with fewer intraepithelial microcysts (r=-0.5436; P=0.0006).

CONCLUSIONS:

FBs were associated with a higher number of intraepithelial microcysts evaluated with en-face OCT. A higher density of microcysts was associated with a lower intraocular pressure and a shorter duration of preserved topical treatment before surgery. En-face OCT provides a simple, noninvasive, and reproducible method to analyze blebs after filtering surgery.

PMID:
26372150
DOI:
10.1097/IJG.0000000000000319
[Indexed for MEDLINE]

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