Analysis of bleb morphology after trabeculectomy with Visante anterior segment optical coherence tomography.
BACKGROUND
To describe the use of anterior segment optical coherence tomography (OCT) in imaging intrableb morphology after trabeculectomy.


METHODS
14 post-trabeculectomy eyes from 11 primary open angle glaucoma and 3 primary angle closure glaucoma subjects were studied. The blebs were classified with reference to slit lamp morphology and bleb function. They included diffuse filtering (n = 7), cystic (n = 2), encapsulated (n = 2) and flattened (n = 3) bleb types. One eye in each patient was imaged with the Visante anterior segment OCT. A vertical scan line of 10 mm consisting of 512 A-scans was positioned at the centre of the bleb. The images were then analysed by built-in software. Intrableb morphologies and structures, including bleb wall thickness, subconjunctival fluid collections, suprascleral fluid space, scleral flap thickness, intrableb intensity (low, medium or high) and the route under the scleral flap were characterised and measured.


RESULTS
Diffuse filtering blebs were found by subconjunctival fluid collections. Suprascleral fluid space and the route under the scleral flap were identified in four of the seven cases. Cystic blebs were composed of a large hyporeflective space with multiloculated fluid collections covered by a thin layer of conjunctiva. Encapsulated blebs had a thick bleb wall with high reflectivity and an enclosed fluid filled space. Flattened blebs demonstrated high scleral reflectivity and no bleb elevation.


CONCLUSIONS
Visante anterior segment OCT can be used for bleb imaging. The different patterns of intrableb morphology identified by OCT were related to slit lamp appearance and bleb function. This information may be useful to study the different surgical outcomes and the process of wound healing in trabeculectomised eyes.
Leung
Christopher Kai-shun
CK
Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong, PRC. tlims00@hotmail.com
Yick
Doris Wai-fong
DW
Kwong
Yolanda Yuen-ying
YY
Li
Felix Chi-hong
FC
Leung
Dexter Yu-lung
DY
Mohamed
Shaheeda
S
Tham
Clement Chee-yung
CC
Chung-chai
Chi
C
Lam
Dennis Shun-chiu
DS
D000328:Adult; D000368:Aged; D000867:Anterior Chamber / Q000473:pathology; D001768:Blister / Q000473:pathology*; D005122:Exudates and Transudates; D015812:Glaucoma, Angle-Closure / Q000601:surgery*; D005902:Glaucoma, Open-Angle / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D041623:Tomography, Optical Coherence / Q000379:methods; D014130:Trabeculectomy