Abstract
Background: To evaluate the relationship between bleb vascularity and surgical outcome one year after mitomycin C (MMC) augmented trabeculectomy. Methods: This was a prospective study of 51 eyes of 44 patients after MMC-augmented primary trabeculectomy with follow-up of 12 months. The total vessel area of a bleb was measured with ImageJ software on color photographs of the bleb on day 1 and 14, then months 1, 3, 6 and 12 after trabeculectomy. Blebs were classified clinically as successful (intraocular pressure (IOP) ≤ 18 mmHg and a >30% reduction in IOP without antiglaucoma medications or additional surgical interventions) or failed. Linear regression analysis was performed to determine the correlation of bleb vascularity with IOP and outcome. Results: At 1 year, 40 eyes (78.4%) were classified as successful and 11 eyes (21.6%) as failed. The mean bleb vascularity at 1, 3 and 12 months after surgery was significantly higher in failed blebs (16.31% vs. 13.01%, p = 0.005, 14.93% vs. 10.15%, p = 0.001, 8.99% vs. 6.37%, p = 0.011, respectively). There were no significant differences in mean bleb vascularity at 1 and 14 days postoperatively in successful and failed blebs. The results revealed a significant association between vessel area at 1 and 3 months after trabeculectomy with IOP at 6 months postoperatively (p = 0.005 and p = 0.009, respectively). Conclusions: In this prospective study, we demonstrated a strong relationship between bleb vascularity and the surgical outcomes of trabeculectomy. Vascularity of the filtering bleb during early postoperative period was not correlated with IOP or success of trabeculectomy at one year. Increased bleb vascularity 1, 3 and 12 months after trabeculectomy appears to predict surgical failure at 1 year after trabeculectomy.
Highlights
The success of glaucoma filtering surgery depends on constant shunting of aqueous humor from the anterior chamber to the subconjunctival space
Yin et al [5] prospectively analyzed the correlation of the vessel area of the filtering bleb after trabeculectomy with surgical outcomes using optical coherence tomography angiography (OCT-A)
Our study provides insight into the relationship between filtering bleb vascularization measured in an objective way on the color photography and the surgical outcomes after trabeculectomy
Summary
The success of glaucoma filtering surgery depends on constant shunting of aqueous humor from the anterior chamber to the subconjunctival space. Increased vascularity of the filtering bleb during first several weeks after surgery may herald subconjunctival fibrosis and failure of the procedure. Yin et al [5] prospectively analyzed the correlation of the vessel area of the filtering bleb after trabeculectomy with surgical outcomes using optical coherence tomography angiography (OCT-A). Several clinical classification systems have long been used to assess the morphology of blebs, e.g., the Indiana Bleb Appearance Grading Scale (IBAGS) [12] and the Moorfields Bleb Grading System (MBGS) [13] These methods subjectively evaluate characteristics of the filtering bleb such as the vessel area on slit-lamp examination. We prospectively evaluated bleb vascularity using color photographs and examined the correlation between vessel area and surgical outcome of trabeculectomy
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