Changes in the morphology of the hyperemic blebs in eyes undergone trabeculectomy with mitomycin C after injection of triamcinolone acetonide during one-year follow-up.

Abstract

To track changes in the morphology of hyperemic blebs in eyes undergone trabeculectomy with mitomycin C 0.02% (MMC) after triamcinolone acetonide (TA) injection. A total of 30 eyes of 30 patients with localized or diffuse hyperemia after trabeculectomy with MMC were enrolled in this prospective interventional case series. Two milligrams of TA were injected at the site of maximal injection. Bleb morphology was graded using Indiana Bleb Appearance Grading Scale (IBAGS), and the Moorfields Bleb Grading System (MBGS) 1week, 1month, 3months, 6months, and 1year after injection. Failure was defined as intraocular pressure (IOP) more than predefined target IOP for each eye, need for an additional surgical procedure, IOP less than 6mmHg, and loss of Light Perception (LP) vision. A total of 27 patients completed a 1-year follow-up period and were included in the final analysis. The mean time interval from trabeculectomy to injection of TA was 5.98 ± 2.57weeks. The bleb height and vascularity in the IBAGS system decreased significantly after the intervention (p < 0.05), with an increase in bleb extension (p = 0.006). Using MBGS, the bleb area did not change significantly following TA injection (p = 0.056) but its height and vascularity significantly decreased in both central and peripheral areas and the surrounding conjunctiva (p = 0.032). The development of a mature cataract was the only complication that could be attributed to TA injection. Injection of TA in hyperemic failing blebs improves bleb morphology by decreasing vascularity and height while increasing the extent with an acceptable safety profile.