Journal of Glaucoma

Skip Navigation LinksHome > June/July 2014 - Volume 23 - Issue 5 > Filtration Bleb Revision Guided by 3-Dimensional Anterior Se...
Journal of Glaucoma:
doi: 10.1097/IJG.0b013e3182741ee6
Case Report

Filtration Bleb Revision Guided by 3-Dimensional Anterior Segment Optical Coherence Tomography

Kojima, Sachi MD; Inoue, Toshihiro MD, PhD; Kawaji, Takahiro MD; Tanihara, Hidenobu MD

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Objective: To elucidate the usefulness of 3-dimensional anterior segment optical coherence tomography (3D AS-OCT) for bleb revision after trabeculectomy.

Design: Case series.

Participants: Two patients who underwent trabeculectomy and subsequent bleb revision.

Methods: Three-dimensional AS-OCT and intraoperative observation.

Main Outcome Measures: AS-OCT and intraoperative observation were analyzed to identify the filtration openings on the scleral flap margin and leaking points.

Results: In 1 case with a leaking bleb, 3D AS-OCT examinations suggested the presence of numerous internal ostia (filtration openings). With 3D AS-OCT guidance, we carefully removed the leaking bleb with peripheral scar tissue. Histopathologic findings showed the presence of a thin bleb wall in the limbal conjunctiva corresponding to the point of aqueous leakage. In another case of an overhanging bleb, 3D AS-OCT examination revealed a thin bleb wall and multiloculated cystic structures. Histopathologic findings showed the presence of a thin region in the conjunctival epithelium in which connective tissue did not support the conjunctival epithelium, which seemed to correspond to the point at which oozing occurred.

Conclusions: Three-dimensional AS-OCT enables evaluation of the internal morphology of filtration blebs and is useful for preoperative guidance for bleb revision.

© 2014 by Lippincott Williams & Wilkins.


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