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J. C. Clarke, P. T. Khaw; The Influence of Bleb Morphology and 5FU on IOP Outcomes Following Trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):180.
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Intraoperative 5FU has a beneficial influence on IOP following trabeculectomy. This study quantifies the influence of bleb size (area) and height on IOP over time and the modifying role 5FU plays.
The blebs of 367 patients who had undergone primary trabeculectomy, either with or without 5FU, were photographed over a minimum of 3 years at regular intervals. The bleb morphology was graded by masked observers with the Moorfields Bleb Grading System. Patients’ blebs were photographed at each of their planned postoperative visits.
There was a trend towards decreasing mean IOP for increasing bleb size, but the standard deviation was large. The distribution of size of bleb between unaugmented and 5FU treated eyes was not significantly different at any of the visits. For smaller blebs, lower mean IOP (p <0.05) for each visit from 12 weeks onwards was found if they had been treated with 5FU. The larger blebs were less influenced by 5FU.The mean IOP of tall blebs was lower in the initial two postoperative weeks (p= <0.05). As the bleb modeled, the bleb height and IOP did not correlate, with higher blebs having higher IOP. By week 26, the height of the bleb again correlated with the IOP and taller blebs had lower IOP (P< 0.05 for weeks 26, 104,156 and 208). The 5FU treated blebs were higher than the placebo treated blebs. The mean IOP within the same height grading was very similar when 5FU and unaugmented blebs were compared.
Larger and taller blebs have lower mean IOP. The correlation between size, height and IOP is not apparent until the 12th postoperative week when the bleb has matured. 5FU particularly influences small blebs to produce lower mean IOP.
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