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Characteristics of early filtering blebs that predict successful trabeculectomy identified via three-dimensional anterior segment optical coherence tomography
  1. Akiko Narita1,
  2. Yuki Morizane2,
  3. Tomoe Miyake1,
  4. Jiro Seguchi1,
  5. Tetsuya Baba3,
  6. Fumio Shiraga2
  1. 1 Department of Ophthalmology, Okayama Saiseikai General Hospital, Okayama, Japan
  2. 2 Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
  3. 3 Department of Ophthalmology, Shirai Eye Hospital, Mitoyo, Japan
  1. Correspondence to Dr Akiko Narita, Department of Ophthalmology, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho Kita-ku Okayama 700-8511, Japan; akiko.n{at}


Background/aims To identify the cross-sectional characteristics of filtering blebs at 2 weeks post-trabeculectomy associated with intraocular pressure (IOP) control at 1 year post-trabeculectomy.

Methods Ninety-nine eyes of 94 patients who had undergone primary trabeculectomy were included in this retrospective consecutive case series study. Surgical success was defined as an IOP ≤15 mm Hg and a >20% reduction in IOP without glaucoma medication or additional glaucoma surgeries at 1 year post-trabeculectomy. Subjects were classified into two groups according to whether surgery was successful or unsuccessful. Blebs were examined using swept-source three-dimensional anterior segment optical coherence tomography and evaluated for quantitative parameters, including maximum height, maximum wall thickness and ratio of hyporeflective space of the wall, as well as qualitative parameters, including multiple parallel hyporeflective layers within the wall (striping phenomenon), decreased visibility of the sclera underlying the bleb (shading phenomenon) and cyst-like structures of the wall.

Results Seventy-seven eyes (77.8%) were assigned to the successful group and 22 (22.2%) to the unsuccessful group. Univariate analysis showed significant differences between the groups regarding maximum bleb height (p=0.044), maximum bleb wall thickness (p=0.017) and the striping phenomenon of the bleb wall (p=0.007). Multivariate logistic regression analysis confirmed that the striping phenomenon at 2 weeks post-trabeculectomy was significantly associated with success at 1 year post-trabeculectomy (OR 3.405; 95% CI 1.059 to 10.947; p=0.040).

Conclusion Taller blebs with thicker walls that showed the striping phenomenon at 2 weeks post-trabeculectomy appeared to predict good IOP control at 1 year post-trabeculectomy.

  • Glaucoma
  • imaging
  • treatment surgery

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  • Contributors All the authors included in this paper fulfil the criteria of authorship. AN designed the study, wrote the manuscript, had full access to all of the data in this study and takes responsibility for the integrity of the data and the accuracy of the data analysis. TM designed the study, collected the data and took part in drafting the manuscript. YM designed the study, interpreted the data and reviewed and edited the manuscript. TB and JS designed the study and made critical revisions to the manuscript for intellectual content. FS participated in analysing and interpreting the data and made critical revisions to the manuscript for intellectual content.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was approved by the Ethics Committee of Okayama Saiseikai General Hospital and was performed in accordance with the tenets of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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