Early trabeculectomy bleb walls on anterior-segment optical coherence tomography

Abstract

To correlate the cross-sectional features of filtering blebs on anterior-segment optical coherence tomography (AS-OCT) 2 weeks after trabeculectomy with bleb function at 6 months. Forty-eight eyes followed for 6 months or more after trabeculectomy with mitomycin C were included. Bleb wall reflectivity of developing blebs on AS-OCT 2 weeks postoperatively was correlated with mature bleb function at 6-month postoperative visit. Developing bleb walls at 2 weeks were classified as uniform in 10/48 eyes (20.8%) and multiform in 38/48 eyes (79.2%). Blebs with uniform reflectivity were significantly more likely to have worse function at 6 months (P < 0.001). Multiform bleb walls had hyporeflective areas seeming to represent loosely-arranged connective tissue (multiple-layer structures), subconjunctival separation, and microcysts. Blebs with multiple-layer structures at 2 weeks were associated with better bleb function at 6 months (P = 0.025). Intraocular pressure (IOP) of developing blebs at 2 weeks did not correlate with bleb function at 6 months (P = 0.471). Bleb wall reflectivity on AS-OCT 2 weeks after surgery may predict bleb function at 6 months, whereas IOP of developing blebs may not.