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Yesenia Yolanda Dorantes Diez, Jose A Paczka, Marco Cuadros, Montserrat Romo Sainz, Miguel Angel Dorantes-Diez; Structural Assessment of Filtering Blebs in Eyes Requiring Digital Compression. A Comparative Study using a Clinical and Tomographic Approach.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):469.
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The clinical appearance of the filtering bleb is crucial to establish the prognosis of glaucoma related to IOP control, so it is important to adopt a classification system for such purpose. Existing clinical classification systems have some limitations and not always give the real picture of a functioning bleb. Structural tests such as OCT or UBM are good alternatives to access the inner morphology of a filtering bleb. This study aims to investigate the capacity of OCT to determine the differences in the appearance of the filtering bleb by comparing eyes that require digital compressions (RDC) to keeping good pressure control as compared to eyes not requiring such maneuver (NRDC).
We assessed a non-consecutive series of cases which underwent mitomycin C supplemented trabeculectomy in a glaucoma specialized center. All blebs were classified according to the Würzburg system (score, 0-12) by an experienced clinician. Anterior segment photographs and weighted score derived from the bleb OCT analysis (score, 0-23), were used to describe the inner aspect of the filtering blebs. Assessment was performed by two masked experienced graders to establish clinical / tomographic scores searching for differences of blebs regarding the status of NRDC versus RDC.
Twenty six blebs from 24 patients were included in the study (16 NRDC and 10 RDC), with no significant differences on age, gender, IOP, visual field index (VFI), vertical c/d ratio, type of glaucoma, and antiglaucoma medications. Würzburg score was not significantly different between groups (NRDC, 10.5 ± 0.9; RDC, 10.1 ± 1.2); on the contrary, a weighted tomographic score was significantly larger in the NRDC group (NRDC, 15.4 ± 0.9; RDC, 13.9 ± 1.2; P = 0.02).
This study demonstrated that the proposed OCT score outperformed Würzburg classification system to differentiate morphology traits of blebs with different filtering functionality.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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