Tan Jeremy C K, Roney Matthew, Choudhary Anshoo, Batterbury Mark, Vallabh Neeru A
St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.
Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia.
Ophthalmol Sci. 2024 Aug 23;5(1):100604. doi: 10.1016/j.xops.2024.100604. eCollection 2025 Jan-Feb.
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.
Cross-sectional study.
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).
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.
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).
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 ( < 0.0001) and DS ( = 0.02) cohorts, demonstrating the association of intraoperative MMC use with increased patency of the scleral flap.
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.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
研究眼前节光学相干断层扫描（AS-OCT）在青光眼滤过手术泡状隆起中观察房水流出途径及巩膜瓣通畅情况的应用。
横断面研究。
112例青光眼患者的205个滤过泡状隆起，这些患者接受了小梁切除术（Trab，n = 97）或深层巩膜切除术（DS，n = 108），手术中使用或未使用丝裂霉素C（MMC）。
使用扫频源AS-OCT光栅扫描，按照标准化方案在矢状面和冠状面成像Trab和DS泡状隆起。根据巩膜瓣和巩膜造口术/小梁-Descemet膜窗（TDW）的表现，将泡状隆起外观分为4类：A-巩膜造口术/TDW不可见；B-巩膜造口术/TDW可见但巩膜瓣与巩膜无明显区分；C-巩膜瓣清晰但边缘与周围巩膜粘连；D-巩膜瓣边缘不与周围巩膜粘连。
手术结果分为完全成功（CS）（眼压[IOP]≤18 mmHg且无需药物治疗）、合格成功（QS）（使用药物时IOP≤18）和失败（F）（IOP>18 mmHg）。
Trab组和DS组的CS、QS和F比例分别为45.0%和29.6%、33.
