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      Bleb Needling in Encapsulated Filtering Blebs: Evaluation by Optical Coherence Tomography

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          Purpose: To evaluate the role of anterior segment optical coherence tomography (OCT) in describing the morphology and outcome of encapsulated filtering blebs after bleb needling. Procedures: Prospective assessment of 9 patients – before, 2 days and 6 months after filtering bleb needling with 5-FU – using slit-lamp examination, Goldmann tonometry and OCT. Results: Before the needling, the average internal height of the cyst was 1.3 ± 0.8 mm. Two days after the needling procedure, the cyst collapsed in 5 patients. After 6 months, the average internal cyst height was 0.7 ± 0.4 mm. All patients with a collapsed cyst at day 2 after needling had controlled regulated IOP without glaucoma medication. Conclusions: The preoperative internal height of the cyst does not correlate with the outcome of the needling. A collapsed cyst at day 2 after needling is an indicator of controlled intraocular pressure, whereas a prominent cyst after 6 months indicates poor function.

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          A pilot study of a system for grading of drainage blebs after glaucoma surgery.

          To develop and evaluate a novel bleb grading scheme for clinical and photographic evaluation. A system for grading bleb photographs using widely applicable parameters was designed, and reference color photographs printed. A prospective masked agreement study was undertaken comparing slit lamp examination with mono and stereo photographs; 36 eyes of 28 patients with previous glaucoma surgery were graded according to defined parameters on a 1 to 10 scale clinically at the slit lamp by four ophthalmologists and two optometrists. Standardized stereo and mono photographs of the blebs were taken on the same day. The photographs were graded at least one week later in a masked fashion by the same observers, with grading of mono and stereo photographs also separated by one week. Analysis was performed to determine the variability and agreement between slit lamp results and photographic results, and to identify the presence of systematic bias. High levels of agreement were found between slit lamp and both stereo and mono photographs for vascularity indices, bleb wall thickness, and bleb elevation. Lower levels of agreement were found for the relative components of demarcated versus diffuse areas of the bleb, and for the total width of the bleb. The interquartile range for the median difference between slit lamp and photograph grading was -1.0 to 1.0 for all criteria except diffuse component (-2.0 to 2.0), and the median difference for all scores was 0.0. The median interobserver difference for all criteria was 0.0; the quartile range for all scores was between -0.5 and 1.0 except for diffuse component and width assessments whose quartiles fell in the -1.75 to 1.0 range. Examiners agreed with photographic grading within +/- 1 in more than 80% of gradings for vascularity and bleb height, within +/- 1 in more than 75% of gradings for bleb wall thickness, within +/- 2 in 61% of bleb width assessments, and +/- 2 in 59% of diffuse component. This bleb grading system is reproducible clinically and photographically. High levels of agreement between scores for photographs versus slit lamp examination were found for most categories, with good interobserver agreement for both photograph and slit lamp grading. Further refinement of scoring and reference photographs is required for optimization, especially for grading of bleb morphology.
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            Needling revision of trabeculectomies bleb morphology and long-term survival.

            To assess the long-term success rate and to determine factors that predict survival after 5-fluorouracil-augmented needling revision of poorly functioning trabeculectomy blebs. Prospective observational cohort study. Eighty-one consecutive patients undergoing bleb needling. Survival analysis was performed after a minimum of 2 years' follow-up. Cox proportional hazards regression analysis was used to test the association between survival and study variables, including bleb morphology. Intraocular pressure (IOP) reduction by >20% and to 20% and to
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              Anterior Segment Imaging: Optical Coherence Tomography Versus Ultrasound Biomicroscopy


                Author and article information

                S. Karger AG
                June 2010
                24 November 2009
                : 224
                : 4
                : 204-208
                Department of Ophthalmology, University of Wuerzburg, Wuerzburg, Germany
                260225 Ophthalmologica 2010;224:204–208
                © 2009 S. Karger AG, Basel

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                Figures: 1, Tables: 2, References: 14, Pages: 5
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