June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Comparative Performance of Würzburg Classification System and a Novel Classification System by Anterior Segment Optical Coherence Tomography in Assessing Filtering Blebs
Author Affiliations & Notes
  • Ana María Ponce Horta
    Instituto de Oftalmología y Ciencias Visuales, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
    Research Department, Unidad de Diagnóstico Temprano del Glaucoma, Guadalajara, Jalisco, Mexico
  • Jose A Paczka
    Instituto de Oftalmología y Ciencias Visuales, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
    Research & Development, Asistencia e Investigación en Glaucoma, Guadalajara, Jalisco, Mexico
  • Daniel Valencia Paredes
    Research & Development, Asistencia e Investigación en Glaucoma, Guadalajara, Jalisco, Mexico
  • Andrea Tornero-Jimenez
    Instituto de Oftalmología y Ciencias Visuales, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
    Research Department, Unidad de Diagnóstico Temprano del Glaucoma, Guadalajara, Jalisco, Mexico
  • Andrea Orozco Garcia
    Instituto de Oftalmología y Ciencias Visuales, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
    Research Department, Unidad de Diagnóstico Temprano del Glaucoma, Guadalajara, Jalisco, Mexico
  • Isis Fernanda Vazquez
    Instituto de Oftalmología y Ciencias Visuales, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
    Research Department, Unidad de Diagnóstico Temprano del Glaucoma, Guadalajara, Jalisco, Mexico
  • Sara Aurora Garcia y Otero Sánchez
    Research Department, Unidad de Diagnóstico Temprano del Glaucoma, Guadalajara, Jalisco, Mexico
  • Footnotes
    Commercial Relationships   Ana Ponce Horta, None; Jose Paczka, None; Daniel Valencia Paredes, None; Andrea Tornero-Jimenez, None; Andrea Orozco Garcia, None; Isis Vazquez, None; Sara Aurora Garcia y Otero Sánchez, None
  • Footnotes
    Support  NONE
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 3429. doi:
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      Ana María Ponce Horta, Jose A Paczka, Daniel Valencia Paredes, Andrea Tornero-Jimenez, Andrea Orozco Garcia, Isis Fernanda Vazquez, Sara Aurora Garcia y Otero Sánchez; Comparative Performance of Würzburg Classification System and a Novel Classification System by Anterior Segment Optical Coherence Tomography in Assessing Filtering Blebs. Invest. Ophthalmol. Vis. Sci. 2021;62(8):3429.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Trabeculectomy is the most practiced glaucoma surgery; however, its success depends on the presence of a filtering bleb and its lowering pressure capacity, usually related to its morphology and permeability. Multiple clinical classification systems have been proposed to describe filtering bleb appearances and their functionality. Optical coherence tomography (OCT) technology has been used to describe the inner morphology of such blebs. The objective of this study is to determine the correlation between the IOP-lowering capacity of a series of post-trabeculectomy filtering blebs and the Würzburg classification (WC) system, as well as with a new anterior segment OCT (AS-OCT) classification system (NOCTCS).

Methods : A cross-sectional study of non-consecutive cases that underwent primary supplemented-MMC trabeculectomy was carried out. Fifty-eight eyes from 39 patients with glaucoma were included. Anterior segment and filtering bleb photographs of the included cases were examined by two independent and masked observers using the WC (score range, 0-12). A series of AS-OCT images were also evaluated by the same observers, using NOCTCS (score range, 0-6) that evaluates 3 tomographic traits of the filtering bleb (wall thickness, cystic spaces and wall inner reflectivity).A weighted score was assigned to each item for every examined case.The data were analyzed with SPSS 25 statistical software, considering significant a p value ≤ 0.05.

Results : Patients had a mean age of 61.4±17.8 years. The cases consisted in a greater proportion of female (71.8%), primary open-angle glaucoma (53.8%), and required digital compression (69.4%). The mean time after trabeculectomy was 52.2±32.1 months. A WC of 9.4±2.7, inversely correlated with mean post-operative IOP values (r=-4.30, p=0.001).The mean NOCTS also correlated but in a weaker manner with the mean IOP (r=-2.41, p=0.034). However, it did not correlate with the mean percentage reduction of IOP (r=0.133, p=0.159). In addition, NOCTS and WC, correlated fairly well (r=0.412, p =0.001).

Conclusions : The Würzburg system outperformed the NOCTS. A combined assessment with clinical and tomographic traits might be more useful to establish key findings associated to better post-trabeculectomy outcomes. Prospective trials using clinical and AS-OCT images of filtering blebs are required.

This is a 2021 ARVO Annual Meeting abstract.

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