Bleb morphology using optical coherence tomography : After primary implantation of XEN gel stent and open conjunctival revision

Abstract

The implantation of a XEN gel stent is an innovative method for filtration surgery using an ab interno approach. The morphological evaluation of the resulting bleb is decisive for surgical success. Bleb revision is frequently needed after XEN implantation and might affect the bleb morphology. Aim of this study was to examine bleb morphology using anterior segment OCT (AS-OCT) and analyze the morphological differences of blebs after primary XEN implantation and after bleb revision. Included were eyes that underwent XEN implantation (Pr-X) or bleb revision after XEN (Re‑X group). An AS-OCT of blebs was performed and images were classified using a novel classification system (the Jenaer bleb grading system, JBGS). Frequency of different tomographic patterns (M) and their correlation with intraocular pressure (IOP) were analyzed. A total of 69eyes (40in the Pr‑X and 29in the Re‑X groups) were included. At the conjunctival level, the most commonM in both groups was subconjunctival spaces (M-C2) followed by intraconjunctival cysts (C1) and no conjunctival changes (C0). No differences of frequencies between the two groups or of IOP between the three Ms were seen. At the tenon level, the most commonly seen Ms in the Pr‑X group were hyporeflective and cavernous changes (M-T2, T3) followed by no changes (M0) and hyperflective changes (T1). In the Re‑X group, the M‑T1 and T2 were most commonly seen followed by T3 and T0. The M‑T2 and T3 in the Pr‑X group and the M‑T1 and T2 in the Re‑X group correlated with lower IOP. An episcleral lake (M-ES1) was seen significantly less frequently in the Pr‑X group compared with Re‑X group where it correlated with lower IOP CONCLUSION: The hyperreflective changes at the tenon level and the presence of an episcleral lake were seen more frequently following bleb revision compared with primary XEN implantation and correlated with lower IOP. The interpretation of bleb morphology using AS-OCT should only be done considering the surgical approach used.