[Assess correlation between bleb morphology at long-term intraocular pressure effect in primary angle-closure glaucoma following trabeculectomy].
OBJECTIVE
To evaluate the correlation between morphologic appearance of blebs at 3 month and long-term intraocular pressure (IOP) effect in patients with primary angle-closure glaucoma (PACG) after trabeculectomy.


METHODS
Multi-centered cases series. Data were collected from 176 patients aged ≥ 40 years with PACG who were participated in a randomized clinical trial that aimed at addressing the efficacy of augmented releasable sutures after trabeculectomy. The bleb morphology was graded using the Modified Indian Bleb Appearance Grading Scale (IBAGS) based on standard photos at 3 month after trabeculectomy. IOPs were measured with Goldmann applanation tonometer. The correlation between bleb components and other selected testing influencing factors and long-term IOP was tested by linear Logistic regression analysis.


RESULTS
150 patients (85.7%) completed 18 months of follow up. IOP was (15.6 ± 5.4) mm Hg at 18 month of post-operation. 135 eyes had an IOP ≤ 21 mm Hg without additional medications, 10 eyes ≥ 21 mm Hg, and the remaining 5 eyes required one or two medications to maintain normal IOP. Using IBAGS system, bleb was graded in 142 eyes as follows: H(0) in 3 eyes, H(1) in 45 eyes, H(2) in 90 eyes, and H(3) in 4 eyes, while V(0) was observed in 66 eyes, V(1-3) in 76 eyes. IOP at 18 months in bleb with microcysts was 2.77 mm Hg lower (β = -2.77, 95%CI = -0.46 to -5.08) than those without microcysts and in bleb with non-vascular was 2.07 mm Hg lower (β = -2.07, 95%CI = -0.15 to -3.98) than those with vascular at 3 months after surgery. IOP was significantly (β = -1.20, 95%CI: -0.00 to -2.40) decreased by 1.2 mm Hg with 10 years of age increase (P < 0.05).


CONCLUSIONS
Early filtering bleb with microcysts, vascular, and age are identified as important factors to predict long-term IOP effect in patients with PACG after trabeculectomy but not early morphological appearance of filtering bleb.
Fu Shun Eye Hospital, Liaoning Province, Fushun 113008, China.
Xing
X
Wagn
Chao
C
Jia
Mei-yan
MY
Feng
Hai-lin
HL
Meng
Su-jie
SJ
Fan
Li-lian
LL
Xie
Lan-ping
LP
Sun
Luo-ru
LR
Liu
Cong
C
Xie
Yi
Y
Peng
Xin
X
Tang
Yuan-bo
YB
Liagn
Gang
G
Zhai
You-qin
YQ
Jiang
Tian-cai
TC
Ye
Ning-li
NL
Wang
D000328:Adult; D000368:Aged; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D014065:Tonometry, Ocular; D014130:Trabeculectomy