Abstract
Purpose :
The success of a filtrating operation depends on the maintenance of the filtering bleb (FB). The purpose of this study is to illustrate the persistance of the FB after Gel-Stent-Implantation (XENTM) in different types of open angle glaucoma by anterior segment OCT (asOCT).
Methods :
78 eyes of 78 patients (32 women, 46 men, age 69 ± 12 years, perimetry: median MD 7,9dB, Min. -11,7dB Max. 20,9dB; median sLV: 6dB, Min. 1,7dB Max.11,5dB) have been examined by asOCT (HRA OCT II Spectralis), at timepoints T1: 97 days (± 53 days) and T2: 699 days (± 242 days): primary open-angle glaucoma (pOAG) (n=50), secondary open-angle glaucoma (sOAG) with pseudoexfoliation (PEX) (n=20) and sOAG with pigmentdispersion (n=8). The FB was morphologically classified as microcystic (m), mixed (mx) and absent (a). The correlation between FB, intraocular pressure (IOP) and medical therapy (TX) was analyzed with IBM SPSS Statistics Version 21.
Results :
At T1 bleb classification was: n=61 (m), n=8 (g), n=9 (a), at T2 the bleb classification was: n=31 (m), n=24 (g), n=23 (a). Surgery resulted in a significant IOP reduction from preoperative (21 ± 8 mmHg) to postoperative IOP at T1 (15 ± 5 mmHg) and T2 (14 ± 4 mmHg) (p<0.01), the difference between IOP-T1 and IOP-T2 is not significant (p>0.01). The number of medications was preoperative 3 (±1) and significantly reduced compared to TX-T1: 0,5 (±1) and T2: 1 (±1) (p<0.01). The need for bleb revision was as follows: no revision n=45, 1 revision n=23 (pOAG n=15, sOAG with PEX n=6, sOAG with pigmentdispersion n=2), two revisions n=7 (pOAG n=6, sOAG with PEX n=1) and 4 revisions n=3 (pOAG n=2, sOAG with PEX, n=1). The revisions included a second stent implantation (n=20), third stent implantation (n=1), needling (n=11), viscocanalostomy (n=1), cyclophotocoagulation (n=2), cyclocryocoagulation (n=1), tenoncyst exzision (n=1).
Conclusions :
FB classification reveals a microcystic structure. FB-revisions are not dependent on glaucoma classification. Further studies with longer follow-up time and larger patient cohorts are necessary to evaluate the effect of glaucoma type and FB persistance.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.