title: Filtration bleb revision guided by 3-dimensional anterior segment optical coherence tomography.
abstract: OBJECTIVE
  To elucidate the usefulness of 3-dimensional anterior segment optical coherence tomography (3D AS-OCT) for bleb revision after trabeculectomy.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Two patients who underwent trabeculectomy and subsequent bleb revision.
  
  
  METHODS
  Three-dimensional AS-OCT and intraoperative observation.
  
  
  METHODS
  AS-OCT and intraoperative observation were analyzed to identify the filtration openings on the scleral flap margin and leaking points.
  
  
  RESULTS
  In 1 case with a leaking bleb, 3D AS-OCT examinations suggested the presence of numerous internal ostia (filtration openings). With 3D AS-OCT guidance, we carefully removed the leaking bleb with peripheral scar tissue. Histopathologic findings showed the presence of a thin bleb wall in the limbal conjunctiva corresponding to the point of aqueous leakage. In another case of an overhanging bleb, 3D AS-OCT examination revealed a thin bleb wall and multiloculated cystic structures. Histopathologic findings showed the presence of a thin region in the conjunctival epithelium in which connective tissue did not support the conjunctival epithelium, which seemed to correspond to the point at which oozing occurred.
  
  
  CONCLUSIONS
  Three-dimensional AS-OCT enables evaluation of the internal morphology of filtration blebs and is useful for preoperative guidance for bleb revision.
authors: Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
authors: Sachi
authors: S
authors: Kojima
authors: Toshihiro
authors: T
authors: Inoue
authors: Takahiro
authors: T
authors: Kawaji
authors: Hidenobu
authors: H
authors: Tanihara
mesh_terms: D000477:Alkylating Agents / Q000008:administration & dosage; D000869:Anterior Eye Segment / Q000473:pathology*; D001768:Blister / Q000473:pathology / Q000601:surgery*; D015355:Glaucoma, Neovascular / Q000601:surgery*; D005902:Glaucoma, Open-Angle / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D010030:Ostomy; D012086:Reoperation; D012590:Sclera / Q000601:surgery; D013524:Surgical Flaps; D041623:Tomography, Optical Coherence / Q000379:methods*; D014065:Tonometry, Ocular; D014130:Trabeculectomy
chemical_list: D000477:Alkylating Agents; D016685:Mitomycin