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The following is a summary of “Discriminatory power of trabeculectomy bleb internal reflectivity and morphology in surgical success using anterior segment optical coherence tomography,” published in the January 2025 issue of Ophthalmology by Tan et al.
The evaluation of trabeculectomy blebs post-operatively has traditionally depended on subjective clinical grading systems conducted at the slit-lamp.
Researchers conducted a retrospective study to analyze the use of swept-source anterior-segment optical coherence tomography (AS-OCT) in objectively measuring bleb internal reflectivity and morphology to differentiate between successful and failed trabeculectomy blebs.
They assessed patients with glaucoma who had undergone trabeculectomy at least 1 year prior. Swept-source AS-OCT was used to capture filtering blebs in the sagittal plane. Standardized regions of interest were segmented, and pixel intensity values along with bleb height were measured. Receiver operating characteristic curves were employed to assess the ability of pixel intensity and bleb morphology to distinguish surgical success from failure.
The results showed 100 eyes from 65 patients were included, with a median follow-up of 7.0 years (IQR 3.2–16 years). The proportions of complete success, qualified success, and failure were 45%, 33%, and 22%, respectively. Bleb height was significantly higher in complete success blebs (1.74 vs 1.25 vs 1.23 mm for Complete success (CS), Qualified success (QS), and Failure (F), P < 0.0001). Mean pixel intensity was lower in complete success blebs (150.8 vs 157.4 vs 167.4 for CS, QS, and F, P = 0.0001). Bleb intensity standard deviation (AUC 0.81), maximal bleb height (AUC 0.76), mean pixel intensity (AUC 0.75), and minimum pixel intensity (AUC 0.75) best discriminated between surgical success and failure.
Investigators concluded that swept-source AS-OCT could quantify bleb internal reflectivity and morphology, potentially distinguishing well-functioning from poorly functioning blebs and assisting surgeons in objectively evaluating post-operative bleb outcomes.
Source: bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-024-03770-6
