title: Analysis of bleb morphology after trabeculectomy with Visante anterior segment optical coherence tomography.
abstract: 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.
authors.affiliation: 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
authors.forename: Christopher Kai-shun
authors.initials: CK
authors.lastname: Leung
authors.forename: Doris Wai-fong
authors.initials: DW
authors.lastname: Yick
authors.forename: Yolanda Yuen-ying
authors.initials: YY
authors.lastname: Kwong
authors.forename: Felix Chi-hong
authors.initials: FC
authors.lastname: Li
authors.forename: Dexter Yu-lung
authors.initials: DY
authors.lastname: Leung
authors.forename: Shaheeda
authors.initials: S
authors.lastname: Mohamed
authors.forename: Clement Chee-yung
authors.initials: CC
authors.lastname: Tham
authors.forename: Chi
authors.initials: C
authors.lastname: Chung-chai
authors.forename: Dennis Shun-chiu
authors.initials: DS
authors.lastname: Lam
mesh_terms: 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