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Utility of Bleb Imaging With Anterior Segment Optical Coherence Tomography in Clinical Decision-making After Trabeculectomy

Singh, Mandeep MRCSEd*; Aung, Tin PhD, FRCSEd* † ‡; Aquino, Maria C. MD*; Chew, Paul T. K. FRCS* †

doi: 10.1097/IJG.0b013e31818d38ab
Original Studies

Aim To determine if imaging of blebs with anterior segment optical coherence tomography (ASOCT) affects clinical decision-making with regard to laser suture lysis (LSL) after trabeculectomy.

Method In this prospective observational case series, we included patients with poorly controlled intraocular pressure (IOP) after standardized trabeculectomy from May to November 2006. One observer assessed IOP, anterior chamber depth and bleb formation, and recorded a decision of whether or not to undertake LSL based on clinical grounds. A second observer masked to clinical data recorded a decision of whether or not to perform LSL based on ASOCT assessment of scleral flap position, presence of a sub-flap space, patency of the internal ostium, and bleb wall thickening. We compared the 2 observers' decisions to determine how ASOCT influenced decision-making.

Results Seven eyes of 7 patients were included. On the basis of clinical examination, LSL was recommended in all 7 (100.0%) cases due to presence of elevated IOP, deep anterior chambers and poorly formed blebs. Using ASOCT, LSL was recommended in 5/7 (71.4%) cases with apposed scleral flaps, absent sub-flap spaces, and absent bleb wall thickening. In 2/7 (28.7%) cases, LSL was not recommended based on ASOCT findings of an elevated scleral flap, a patent sub-flap space, and bleb wall thickening. All 7 patients had good IOP control and formed blebs at a mean of 8.4±2.6 months after trabeculectomy, with a mean IOP of 14.3±3.2 mm Hg with no medications.

Conclusions This small study suggests that ASOCT imaging may affect decision-making with regard to LSL by providing information not apparent on clinical examination.

*Department of Ophthalmology, National University Hospital

Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore

Singapore National Eye Center, Singapore

Financial Support: Supported by a grant from the National University of Singapore.

Reprints: Paul T. K. Chew, FRCS, Department of Ophthalmology, Level 3 Main Building 1, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074 (e-mail:

Received for publication April 3, 2008; accepted September 7, 2008

© 2009 Lippincott Williams & Wilkins, Inc.