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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 Ex-PRESS implantation according to the position of the device. Bleb morphology may be significantly affected by the position of the device within the scleral bed. In anteriorly positioned Ex-PRESS implant (a) (0-1 mm from the limbal margin (L); arrowhead), the bleb presents features of a failed filtration, with a flat shape (asterisk), limited subconjunctival area (scattered cysts), and a hyperreflective bleb wall. Conversely, in posteriorly positioned Ex-PRESS implant (b) (1 to 2-3 mm from the limbal margin (L); arrowhead), the bleb presents features of an effective filtration, with a cystic multilobed shape (asterisk), a wide subconjunctival filtration area, and a low reflective bleb wall (RTVue, Optovue, Inc, CA).
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fig5: Filtering bleb features after Ex-PRESS implantation according to the position of the device. Bleb morphology may be significantly affected by the position of the device within the scleral bed. In anteriorly positioned Ex-PRESS implant (a) (0-1 mm from the limbal margin (L); arrowhead), the bleb presents features of a failed filtration, with a flat shape (asterisk), limited subconjunctival area (scattered cysts), and a hyperreflective bleb wall. Conversely, in posteriorly positioned Ex-PRESS implant (b) (1 to 2-3 mm from the limbal margin (L); arrowhead), the bleb presents features of an effective filtration, with a cystic multilobed shape (asterisk), a wide subconjunctival filtration area, and a low reflective bleb wall (RTVue, Optovue, Inc, CA).

Mentions: Also the position of the device, in relation to the limbal margin, may have a significant effect on bleb morphology and final surgical success. In the same case, series blebs showed a smaller subconjunctival area, a hyperreflective wall with a flat shape (Figure 5(a)) when the device was placed anteriorly (arrowhead, 0 to 1 mm from the limbus). Oppositely, a higher subconjunctival filtration area, a lower reflective wall, and a more diffuse or cystic shape were evident when Ex-PRESS was implanted more posteriorly in the scleral bed (1 to 2 mm from the limbus) (Figure 5(b)) (RTVue, Optovue, Inc., CA). When comparing the overall surgical success (six-month follow-up, one third reduction of IOP from baseline), the Ex-PRESS devices implanted posteriorly presented a significantly higher success rate compared to devices implanted anteriorly (75% versus 38%; P < 0.001). By hypothesizing, this could be due to the fact that a device implanted too anteriorly do not allow a useful posterior AH outflow, which is critical to promote the formation of a diffuse and functioning filtering bleb.


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 Ex-PRESS implantation according to the position of the device. Bleb morphology may be significantly affected by the position of the device within the scleral bed. In anteriorly positioned Ex-PRESS implant (a) (0-1 mm from the limbal margin (L); arrowhead), the bleb presents features of a failed filtration, with a flat shape (asterisk), limited subconjunctival area (scattered cysts), and a hyperreflective bleb wall. Conversely, in posteriorly positioned Ex-PRESS implant (b) (1 to 2-3 mm from the limbal margin (L); arrowhead), the bleb presents features of an effective filtration, with a cystic multilobed shape (asterisk), a wide subconjunctival filtration area, and a low reflective bleb wall (RTVue, Optovue, Inc, CA).
© Copyright Policy
Related In: Results  -  Collection

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

fig5: Filtering bleb features after Ex-PRESS implantation according to the position of the device. Bleb morphology may be significantly affected by the position of the device within the scleral bed. In anteriorly positioned Ex-PRESS implant (a) (0-1 mm from the limbal margin (L); arrowhead), the bleb presents features of a failed filtration, with a flat shape (asterisk), limited subconjunctival area (scattered cysts), and a hyperreflective bleb wall. Conversely, in posteriorly positioned Ex-PRESS implant (b) (1 to 2-3 mm from the limbal margin (L); arrowhead), the bleb presents features of an effective filtration, with a cystic multilobed shape (asterisk), a wide subconjunctival filtration area, and a low reflective bleb wall (RTVue, Optovue, Inc, CA).
Mentions: Also the position of the device, in relation to the limbal margin, may have a significant effect on bleb morphology and final surgical success. In the same case, series blebs showed a smaller subconjunctival area, a hyperreflective wall with a flat shape (Figure 5(a)) when the device was placed anteriorly (arrowhead, 0 to 1 mm from the limbus). Oppositely, a higher subconjunctival filtration area, a lower reflective wall, and a more diffuse or cystic shape were evident when Ex-PRESS was implanted more posteriorly in the scleral bed (1 to 2 mm from the limbus) (Figure 5(b)) (RTVue, Optovue, Inc., CA). When comparing the overall surgical success (six-month follow-up, one third reduction of IOP from baseline), the Ex-PRESS devices implanted posteriorly presented a significantly higher success rate compared to devices implanted anteriorly (75% versus 38%; P < 0.001). By hypothesizing, this could be due to the fact that a device implanted too anteriorly do not allow a useful posterior AH outflow, which is critical to promote the formation of a diffuse and functioning filtering bleb.

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