Bleb analysis by using anterior segment optical coherence tomography in two different methods of trabeculectomy.

PURPOSE: To investigate the correlation between bleb morphology and IOP control via the modified Indiana Bleb Appearance Grading Scale (IBAGS) and anterior-segment optical coherence tomography (AS-OCT) in two different trabeculectomy (TLE) groups.

METHODS

This study involved 94 eyes with primary open angle glaucoma that underwent two different TLE methods: limbal-based TLE (group I, 62 eyes) and fornix-based TLE (group II, 32). IOP control was defined as successful with an IOP ≤ 20 mm Hg and ≥20% reduction of preoperative IOP. IBAGS and various parameters of the bleb height, extent, wall thickness, ciliochoroidal detachment (CCD), and lake under the scleral flap (LUSF) were obtained by slit-lamp and AS-OCT, respectively. Correlation between IOP control and IBAGS/AS-OCT parameters were assessed by SAS.

RESULTS

Both groups had the same success rate. As to correlation between IOP control and IBAGS, extent and Seidel were the best-paired parameters in group I (Cp = 3.0402, R = 0.6401), yet no parameter was significant in group II (maximum R = 0.1599). As to correlation between IOP control and AS-OCT, the combinations of height, extent, and the minimum value of bleb wall thickness were significant (Cp = 0.2037, 0.2314, R = 0.4336, 0.4330) in group I. In group II, no parameter was significant, except CCD and/or LUSF (P = 0.032). As to coincidence of IBAGS and AS-OCT parameters, height and extent in group I (P = 0.000, P = 0.000) and height in group II were statistically significant (P = 0.020).

CONCLUSIONS

IOP control in limbal-based TLE seemed to be more dependent on the large size and thinned-wall bleb than that in fornix-based TLE.