Visualization of Scleral Flap Patency in Glaucoma Filtering Blebs Using OCT

IF 3.2 Q1 OPHTHALMOLOGY Ophthalmology science Pub Date : 2024-08-23 DOI:10.1016/j.xops.2024.100604
Jeremy C.K. Tan MD, FRANZCO , Matthew Roney BSc(Hons) , Anshoo Choudhary FRCOphth, MD , Mark Batterbury FRCOphth , Neeru A. Vallabh FRCOphth, PhD
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Abstract

Purpose

To investigate the use of anterior-segment OCT (AS-OCT) to visualize the aqueous outflow pathway and patency of the scleral flap in glaucoma filtration surgery blebs.

Design

Cross-sectional study.

Subjects

Two hundred five filtering blebs of 112 patients with glaucoma who had undergone trabeculectomy (Trab, n = 97) or deep sclerectomy (DS, n = 108) surgery with/without mitomycin-C (MMC).

Methods

Swept-source AS-OCT raster slices were used to image the Trab and DS blebs in sagittal and coronal planes using a standardized protocol. Bleb appearances were classified into 4 categories based on the scleral flap and sclerostomy/trabeculo-descemet window (TDW) appearance: A—sclerostomy/TDW not visible; B—sclerostomy/TDW visible but scleral flap indiscriminate from sclera; C—scleral flap distinct but edges adherent to surrounding sclera; D—scleral flap edges non adherent to surrounding sclera.

Main Outcome Measures

Surgical outcomes were classified into complete success (CS) (intraocular pressure [IOP] ≤18 mmHg with no medications), qualified success (QS) (IOP ≤18 with medications), and failure (F) (IOP >18 mmHg).

Results

The proportions of CS, QS, and F in the Trab and DS cohorts were 45.0% and 29.6%, 33.0% and 31.5%, 22.0% and 38.9% respectively, with a median postoperative follow-up of 8.4 years (standard deviation 7.9; interquartile range 3.2–9.0). In QS and failed blebs, category C (Trab, 53.7%; DS, 52.5%) accounted for the majority of scleral flap appearances, followed by categories A and B. Category D (86.0%; 71.9%) accounted for the majority of appearances in Trab and DS blebs with CS. There was a significantly greater proportion of MMC use in categories C and D compared with categories A and B in both Trab (P < 0.0001) and DS (P = 0.02) cohorts, demonstrating the association of intraoperative MMC use with increased patency of the scleral flap.

Conclusions

Swept-source AS-OCT may be used to visualize the position and patency of the sclerostomy/TDW and scleral flap in relation to surrounding structures in both sagittal and coronal planes. Although free scleral flap edges are primarily correlated with MMC use, it may also correlate with surgical success. Anterior-segment OCT may be used to complement subjective bleb grading at the slit lamp in the assessment of filtering blebs.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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利用 OCT 观察青光眼滤过性裂孔中巩膜瓣的通畅性
目的研究用前节段OCT(AS-OCT)观察青光眼滤过手术出血点的水流出路径和巩膜瓣的通畅性。研究对象112名青光眼患者的25个滤过性出血点,这些患者接受了小梁切除术(Trab,97人)或深部巩膜切除术(DS,108人)手术,术中使用/未使用丝裂霉素-C(MMC)。方法采用标准化方案,使用扫源AS-OCT光栅切片对Trab和DS出血点进行矢状面和冠状面成像。根据巩膜瓣和巩膜造口/泪囊窗(TDW)的外观,将出血点外观分为 4 类:A-硬化剂/TDW不可见;B-硬化剂/TDW可见,但巩膜瓣与巩膜无差别;C-巩膜瓣明显,但边缘与周围巩膜粘连;D-巩膜瓣边缘与周围巩膜无粘连。主要结果测量手术结果分为完全成功(CS)(眼压[IOP]≤18 mmHg,无药物治疗)、合格成功(QS)(眼压≤18,有药物治疗)和失败(F)(眼压>18 mmHg)。结果 Trab 和 DS 组中 CS、QS 和 F 的比例分别为 45.0% 和 29.6%、33.0% 和 31.5%、22.0% 和 38.9%,术后随访中位数为 8.4 年(标准差为 7.9;四分位间范围为 3.2-9.0)。在QS和失败出血中,C类(Trab,53.7%;DS,52.5%)占巩膜瓣出现的绝大多数,其次是A类和B类;在有CS的Trab和DS出血中,D类(86.0%;71.9%)占出现的绝大多数。在 Trab(P < 0.0001)和 DS(P = 0.02)队列中,C 类和 D 类使用 MMC 的比例明显高于 A 类和 B 类,这表明术中使用 MMC 与巩膜瓣的通畅性增加有关。虽然游离巩膜瓣边缘主要与 MMC 的使用有关,但它也可能与手术成功与否有关。在评估滤过性出血时,前段 OCT 可用于补充裂隙灯下的主观出血分级。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Ophthalmology science
Ophthalmology science Ophthalmology
CiteScore
3.40
自引率
0.00%
发文量
0
审稿时长
89 days
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Barriers to Extracting and Harmonizing Glaucoma Testing Data: Gaps, Shortcomings, and the Pursuit of FAIRness Severity Scale of Diabetic Macular Ischemia Based on the Distribution of Capillary Nonperfusion in OCT Angiography Editorial Board Table of Contents Cover
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