Abstract
With the advent of newer technologies, real-time anterior segment optical coherence tomography (OCT) integrated with the operating microscope has become possible. We are proposing the technique of bleb revision with greater precision under direct visualization of bleb anatomy and extent of tissue depth allowing better localization and easy maneuvering with lesser complications. In this surgical technique, bleb revision was performed using intraoperative real-time OCT incorporated in OPMI LUMERA 700 microscope. Live surgical and OCT view were seen on a common screen together. A moderately elevated, diffuse functional bleb was noted after three months of bleb revision in both cases with controlled intraocular pressure. Intraoperative OCT-guided bleb-sparing epithelial exchange is an adjunctive technique for bleb repair surgery with an increased precision of surgery which can reduce complications, minimize surgical time and maximize surgical outcome.
Highlights
Long-term results of trabeculectomy have improved over time with modifications to surgical technique,[1] application of antifibroblastic agents like mitomycin-C (MMC), and use of releasable sutures
Ehlers et al stated that the use of microscope-mounted intraoperative optical coherence tomography can modify the surgical decisions of both anterior and posterior segment surgeries.[3, 4]
The anterior segment optical coherence tomography (ASOCT) of the filtering blebs postoperatively showed a decrease in the bleb height, a thicker epithelium, and smaller hyporeflective spaces within the bleb tissue [Figures 3a and 3b]
Summary
Long-term results of trabeculectomy have improved over time with modifications to surgical technique,[1] application of antifibroblastic agents like mitomycin-C (MMC), and use of releasable sutures. The intraoperative use of MMC and 5-fluorouracil in trabeculectomy has increased the susceptibility of thin avascular blebs.[2] These. Ehlers et al stated that the use of microscope-mounted intraoperative optical coherence tomography (iOCT) can modify the surgical decisions of both anterior and posterior segment surgeries.[3, 4] Various surgical or nonincisional methods using cyanoacrylate glue or autologous blood injections for bleb revision have been described.[5,6,7] Our technique of bleb-sparing epithelial exchange (BSEX) is well established and safe.[8, 9]
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