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Abstract #72773 Published in IGR 18-4
Comparison of bleb morphology between trabeculectomy and deep sclerectomy using a clinical grading scale and anterior segment optical coherence tomography
Oh LJ; Wong E; Lam J; Clement CIClinical and Experimental Ophthalmology 2017; 45: 701-707
IMPORTANCE: The role of the filtration bleb for IOP management following trabeculectomy (TRAB) and deep sclerectomy (DS) in glaucoma is highlighted in this study. BACKGROUND: This study serves to analyse the bleb morphology and IOP using the Indiana Bleb Appearance Grading Scale (IBAGS) and the anterior-segment optical coherence tomography (AS-OCT) postoperatively and at 3 months. DESIGN: The retrospective study was performed by a single surgeon. PARTICIPANTS: Twenty-eight patients with open-angle glaucoma were recruited into the study, 14 in each of the TRAB (fornix) and DS groups. METHODS: The surgical intervention was dependent on the irido-corneal angle configuration on gonioscopy. MAIN OUTCOME MEASURES: Pre-operatively, we collected visual acuity, medications and IOP. Three months postoperatively, we used the IBAGS to assess bleb morphology, including bleb height, extent, vascularity and leak. AS-OCT was also used to assess bleb height, thickness, cyst presence and posterior and intrascleral fluid. RESULTS: Central corneal thickness and mean IOP at 3 months postoperatively were significantly lower in the TRAB group (7.75 vs. 12.27 mmHg; P = 0.005). Blebs that were significantly higher, broader and less vascular compared with DS were displayed by TRAB eyes. The AS-OCT measurements confirmed TRAB eyes had significantly higher blebs and increased intrascleral fluid compared with DS eyes. CONCLUSIONS AND RELEVANCE: Significant differences in bleb morphology, correlating with improved IOP outcomes in TRAB eyes compared with DS eyes in patients with open-angle glaucoma, were showed by both the IBAGS and AS-OCT. Despite the limitations of each classification system, a higher bleb with an increased aqueous reservoir is associated with optimal IOP results.
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Classification:
12.8.3 Non-perforating (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
6.9.2.1 Anterior (Part of: 6 Clinical examination methods > 6.9 Computerized image analysis > 6.9.2 Optical coherence tomography)
12.8.1 Without tube implant (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
