Imaging of Trabeculectomy Blebs Using Anterior Segment Optical Coherence Tomography

Objective: To image trabeculectomy blebs using anterior segment optical coherence tomography (AS-OCT). Design: Prospective cross-sectional study. Participants: Fifty-five patients who had previously undergone trabeculectomy surgery. Methods: All blebs were imaged with a prototype of the AS-OCT. Standardized color monophotographs of blebs were also obtained. Blebs were assessed for the following qualitative features: bleb height, thickness of the conjunctiva in the bleb wall, presence of cystic spaces within the bleb wall, apposition of the scleral flap to underlying sclera, and patency of the internal ostium. Main Outcome Measures: For blebs with preoperative intraocular pressure (IOP) > 18 mmHg with or without ocular hypotensive medication, success was defined as last recorded IOP≤18 mmHg without topical glaucoma medication. For blebs with preoperative IOP≤18 mmHg with ocular hypotensive medication, success was defined last recorded IOP≤18 mmHg with cessation of ocular hypotensive medication. For blebs with preoperative IOP≤18 mmHg without ocular hypotensive medication, a 20% drop in IOP with no ocular hypotensive medication was accepted as success. Results: Seventy-eight blebs in eyes of 55 patients were imaged. There were 32 (58.2%) men and the mean age was 68.9±11.5 years. Fifty-seven (73.1%) blebs were classified as successful. Anterior segment optical coherence tomography identified the following bleb characteristics: total bleb height, bleb cavity, bleb wall thickness, tangential and radial dimensions, scleral flap thickness, and patency of the internal ostium. The majority of successful blebs displayed thickening of the bleb wall. Failed blebs were mostly low and were characterized by ostial occlusion, apposition of conjunctiva-episclera to sclera or apposition of the scleral flap to its bed. Thickening of the bleb wall was typically absent. Conclusions: AS-OCT is a promising tool to image trabeculectomy blebs. It was able to demonstrate features of bleb morphology not visible with the slit lamp.