Abstract
BackgroundTo determine the agreement between intraocular pressure and the ‘Wuerzburg bleb classification score’, as well as between single items of the score and intraocular pressure. Interobserver variability was analyzed.Methods57 post-trabeculectomy eyes were included. Colour photographs were used to score the filtering bleb in accordance to the Wuerzburg bleb classification score by two different examiners. At the same visit, clinical data such as intraocular pressure, best corrected visual acuity, slit lamp biomicroscopy and medical history were obtained by another examiner.ResultsAfter trabeculectomy, 42 out of 57 eyes (73.7%) reached the target pressure (≤21mmHg, and intraocular pressure reduction of at least 20%, without antiglaucoma medication, and without any additional intervention). Fair agreement was found between intraocular pressure and Wuerzburg bleb classification score ≥8 points and ≥7 points (kappa 0.24 and 0.27, respectively). Analyzing the subgroups of the morphological criteria, best agreement was found between occurrence of microcysts and target intraocular pressure (к 0.22 – 0.34).ConclusionsEvaluating filtering blebs after trabeculectomy by using the Wuerzburg bleb classification score is a good technique for predicting intraocular pressure control in eyes attaining a minimum score of seven points. The presence of microcysts on the filtering bleb predicts that the eye is likely to attain target pressure.
Highlights
To determine the agreement between intraocular pressure and the ‘Wuerzburg bleb classification score’, as well as between single items of the score and intraocular pressure
(WBCS)’, based on the bleb classification as described by Picht and Grehn [10,11] was the first standardized grading system and was introduced in a prospective study to investigate the influence of clear cornea phacoemulsification on filtering bleb morphology, function and intraocular pressure (IOP) [13]
The control of IOP remains the principal goal of all current glaucoma treatment to avoid progression of optic nerve damage [20,21,22], and the main aim of this study was to analyse the agreement between the morphological appearance of the filtering bleb using the WBCS and the IOP
Summary
To determine the agreement between intraocular pressure and the ‘Wuerzburg bleb classification score’, as well as between single items of the score and intraocular pressure. The careful clinical bleb evaluation following the WBCS includes the items vascularisation, corkscrew vessels, encapsulation and microcysts. In a semi quantitative analysis in 1998, Picht and Grehn found out that filtering blebs with favourable outcomes had a higher quantity of microcysts, a lower quantity of conjunctival and corkscrew vessels, a lower prevalence of encapsulation, and a decrease in height compared to filtering blebs with unfavourable outcome [11]. We looked for agreements between single items of the WBCS and the IOP and we analysed the interobserver variability of the WBCS. In this first study we wanted to evaluate the usability and overall correlation of the WBCS and IOP in clinical practice
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