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Anterior segment optical coherence tomography imaging of conjunctival filtering blebs after glaucoma surgery.

Mastropasqua R, Fasanella V, Agnifili L, Curcio C, Ciancaglini M, Mastropasqua L - Biomed Res Int (2014)

Bottom Line: In patients undergoing surgery, AS-OCT is crucial in the evaluation of the filtering bleb functionality, permitting a combined qualitative and quantitative analysis.In this field, AS-OCT may help clinicians in distinguishing between functioning and nonfunctioning blebs by classifying their macroscopic morphology, describing bleb-wall features, bleb cavity, and scleral opening.This information is critical in recognizing signs of filtration failure earlier than the clinical approach and in planning the appropriate timing for management procedures in failing blebs.

View Article: PubMed Central - PubMed

Affiliation: Ophthalmology Unit, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, 53593 Verona, Italy.

ABSTRACT
Time domain (TD) and spectral domain (SD) optical coherence tomography (OCT) are cross-sectional, noncontact, high-resolution diagnostic modalities for posterior and anterior segment (AS) imaging. The AS-OCT provides tomographic imaging of the cornea, iris, lens, and anterior chamber (AC) angle in several ophthalmic diseases. In glaucoma, AS-OCT is utilized to evaluate the morphology of AS structures involved in the pathogenesis of the disease, to obtain morphometric measures of the AC, to evaluate the suitability for laser or surgical approaches, and to assess modifications after treatment. In patients undergoing surgery, AS-OCT is crucial in the evaluation of the filtering bleb functionality, permitting a combined qualitative and quantitative analysis. In this field, AS-OCT may help clinicians in distinguishing between functioning and nonfunctioning blebs by classifying their macroscopic morphology, describing bleb-wall features, bleb cavity, and scleral opening. This information is critical in recognizing signs of filtration failure earlier than the clinical approach and in planning the appropriate timing for management procedures in failing blebs. In this review, we summarize the applications of AS-OCT in the conjunctival bleb assessment.

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Filtering bleb features after trabeculectomy and Ex-PRESS implantation. Conjunctival filtering bleb after successful MMC/Ex-PRESS (P200) implantation (arrowhead) (a) shows a uniform and regular diffuse pattern, with AH drainage well extended posteriorly to the scleral flap. Differently, bleb after MMC/trabeculectomy (b) presents a cystic pattern with a less regular shape (RTVue, Optovue, Inc, CA).
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fig4: Filtering bleb features after trabeculectomy and Ex-PRESS implantation. Conjunctival filtering bleb after successful MMC/Ex-PRESS (P200) implantation (arrowhead) (a) shows a uniform and regular diffuse pattern, with AH drainage well extended posteriorly to the scleral flap. Differently, bleb after MMC/trabeculectomy (b) presents a cystic pattern with a less regular shape (RTVue, Optovue, Inc, CA).

Mentions: In large case series of patients implanted with Ex-PRESS (P200 model)/MMC or who underwent trabeculectomy/MMC (unpublished data), we observed with SD-OCT (RTVue, Optovue, Inc., CA) that blebs after Ex-PRESS implants presented a diffuse shape, with a uniform and posteriorly directed AH filtration, probably expression of a regulated AH passage toward the subconjunctiva (Figure 4(a)). Conversely, filtering blebs derived from trabeculectomy were more commonly cystic with a less extended (even though higher) subconjunctival area, probably expression of a more turbulent AH passage toward the subconjunctiva (Figure 4(b)). On this basis, further structured studies assessing bleb morphology with AS-OCT in patients undergoing trabeculectomy or Ex-PRESS device are warranted.


Anterior segment optical coherence tomography imaging of conjunctival filtering blebs after glaucoma surgery.

Mastropasqua R, Fasanella V, Agnifili L, Curcio C, Ciancaglini M, Mastropasqua L - Biomed Res Int (2014)

Filtering bleb features after trabeculectomy and Ex-PRESS implantation. Conjunctival filtering bleb after successful MMC/Ex-PRESS (P200) implantation (arrowhead) (a) shows a uniform and regular diffuse pattern, with AH drainage well extended posteriorly to the scleral flap. Differently, bleb after MMC/trabeculectomy (b) presents a cystic pattern with a less regular shape (RTVue, Optovue, Inc, CA).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4127298&req=5

fig4: Filtering bleb features after trabeculectomy and Ex-PRESS implantation. Conjunctival filtering bleb after successful MMC/Ex-PRESS (P200) implantation (arrowhead) (a) shows a uniform and regular diffuse pattern, with AH drainage well extended posteriorly to the scleral flap. Differently, bleb after MMC/trabeculectomy (b) presents a cystic pattern with a less regular shape (RTVue, Optovue, Inc, CA).
Mentions: In large case series of patients implanted with Ex-PRESS (P200 model)/MMC or who underwent trabeculectomy/MMC (unpublished data), we observed with SD-OCT (RTVue, Optovue, Inc., CA) that blebs after Ex-PRESS implants presented a diffuse shape, with a uniform and posteriorly directed AH filtration, probably expression of a regulated AH passage toward the subconjunctiva (Figure 4(a)). Conversely, filtering blebs derived from trabeculectomy were more commonly cystic with a less extended (even though higher) subconjunctival area, probably expression of a more turbulent AH passage toward the subconjunctiva (Figure 4(b)). On this basis, further structured studies assessing bleb morphology with AS-OCT in patients undergoing trabeculectomy or Ex-PRESS device are warranted.

Bottom Line: In patients undergoing surgery, AS-OCT is crucial in the evaluation of the filtering bleb functionality, permitting a combined qualitative and quantitative analysis.In this field, AS-OCT may help clinicians in distinguishing between functioning and nonfunctioning blebs by classifying their macroscopic morphology, describing bleb-wall features, bleb cavity, and scleral opening.This information is critical in recognizing signs of filtration failure earlier than the clinical approach and in planning the appropriate timing for management procedures in failing blebs.

View Article: PubMed Central - PubMed

Affiliation: Ophthalmology Unit, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, 53593 Verona, Italy.

ABSTRACT
Time domain (TD) and spectral domain (SD) optical coherence tomography (OCT) are cross-sectional, noncontact, high-resolution diagnostic modalities for posterior and anterior segment (AS) imaging. The AS-OCT provides tomographic imaging of the cornea, iris, lens, and anterior chamber (AC) angle in several ophthalmic diseases. In glaucoma, AS-OCT is utilized to evaluate the morphology of AS structures involved in the pathogenesis of the disease, to obtain morphometric measures of the AC, to evaluate the suitability for laser or surgical approaches, and to assess modifications after treatment. In patients undergoing surgery, AS-OCT is crucial in the evaluation of the filtering bleb functionality, permitting a combined qualitative and quantitative analysis. In this field, AS-OCT may help clinicians in distinguishing between functioning and nonfunctioning blebs by classifying their macroscopic morphology, describing bleb-wall features, bleb cavity, and scleral opening. This information is critical in recognizing signs of filtration failure earlier than the clinical approach and in planning the appropriate timing for management procedures in failing blebs. In this review, we summarize the applications of AS-OCT in the conjunctival bleb assessment.

Show MeSH
Related in: MedlinePlus