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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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Effects of 5-FU injections on filtering bleb morphology. Blebs injected with subconjunctival 5-FU (extrableb injection) showed a less reflective and thicker bleb wall, with multiple intra- and subepithelial fluid filled cavities (b), compared to eyes treated with PBS, which presented opposite signs without evidence of filtration (a). Arrowhead represents Ex-PRESS device (RTVue, Optovue, Inc, CA).
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fig7: Effects of 5-FU injections on filtering bleb morphology. Blebs injected with subconjunctival 5-FU (extrableb injection) showed a less reflective and thicker bleb wall, with multiple intra- and subepithelial fluid filled cavities (b), compared to eyes treated with PBS, which presented opposite signs without evidence of filtration (a). Arrowhead represents Ex-PRESS device (RTVue, Optovue, Inc, CA).

Mentions: Subconjunctival Injections of Antimetabolites. To date, studies on the application of AS-OCT after subconjunctival antimetabolites injections are not available. Our group recently conducted a prospective randomized, double blind, six-month study (unpublished data, currently under peer review) to compare the long-term effect of peribleb injection of 5-fluorouracil (5-FU; three weekly injections for three weeks) versus phosphate buffered solution (PBS; three weekly injections for three weeks) in patients with failing blebs (progressive IOP increase in the last two weeks, flattening or encapsulation of the conjunctiva at slit lamp, decrease of the density of intraepithelial microcysts and stromal scarring at LSCM, bleb-wall hyper-reflectivity at AS-OCT). In blebs injected with 5-FU the SD-OCT (RTVue, Optovue, Inc., CA) showed a less reflective and thicker bleb wall, with multiple intra- and subepithelial fluid filled cavities, compared to eyes treated with PBS (Figure 7).


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)

Effects of 5-FU injections on filtering bleb morphology. Blebs injected with subconjunctival 5-FU (extrableb injection) showed a less reflective and thicker bleb wall, with multiple intra- and subepithelial fluid filled cavities (b), compared to eyes treated with PBS, which presented opposite signs without evidence of filtration (a). Arrowhead represents Ex-PRESS device (RTVue, Optovue, Inc, CA).
© Copyright Policy
Related In: Results  -  Collection

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

fig7: Effects of 5-FU injections on filtering bleb morphology. Blebs injected with subconjunctival 5-FU (extrableb injection) showed a less reflective and thicker bleb wall, with multiple intra- and subepithelial fluid filled cavities (b), compared to eyes treated with PBS, which presented opposite signs without evidence of filtration (a). Arrowhead represents Ex-PRESS device (RTVue, Optovue, Inc, CA).
Mentions: Subconjunctival Injections of Antimetabolites. To date, studies on the application of AS-OCT after subconjunctival antimetabolites injections are not available. Our group recently conducted a prospective randomized, double blind, six-month study (unpublished data, currently under peer review) to compare the long-term effect of peribleb injection of 5-fluorouracil (5-FU; three weekly injections for three weeks) versus phosphate buffered solution (PBS; three weekly injections for three weeks) in patients with failing blebs (progressive IOP increase in the last two weeks, flattening or encapsulation of the conjunctiva at slit lamp, decrease of the density of intraepithelial microcysts and stromal scarring at LSCM, bleb-wall hyper-reflectivity at AS-OCT). In blebs injected with 5-FU the SD-OCT (RTVue, Optovue, Inc., CA) showed a less reflective and thicker bleb wall, with multiple intra- and subepithelial fluid filled cavities, compared to eyes treated with PBS (Figure 7).

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