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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

Journal of Glaucoma:
doi: 10.1097/IJG.0b013e3182741ee6
Case Report
Abstract

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.

Author Information

Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan

Supported in part by Grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sport, Science, and Technology (MEXT), Tokyo, Japan, and from the Ministry of Health, Labor, and Welfare, Tokyo, Japan.

Disclosure: The authors declare no conflict of interest.

Reprints: Toshihiro Inoue, MD, PhD, Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan (e-mail: noel@da2.so-net.ne.jp).

Received March 18, 2012

Accepted August 28, 2012

© 2014 by Lippincott Williams & Wilkins.