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Changes in the morphology of the hyperemic blebs in eyes undergone trabeculectomy with mitomycin C after injection of triamcinolone acetonide during one-year follow-up

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Abstract

Purpose

To track changes in the morphology of hyperemic blebs in eyes undergone trabeculectomy with mitomycin C 0.02% (MMC) after triamcinolone acetonide (TA) injection.

Methods

A total of 30 eyes of 30 patients with localized or diffuse hyperemia after trabeculectomy with MMC were enrolled in this prospective interventional case series. Two milligrams of TA were injected at the site of maximal injection. Bleb morphology was graded using Indiana Bleb Appearance Grading Scale (IBAGS), and the Moorfields Bleb Grading System (MBGS) 1 week, 1 month, 3 months, 6 months, and 1 year after injection. Failure was defined as intraocular pressure (IOP) more than predefined target IOP for each eye, need for an additional surgical procedure, IOP less than 6 mmHg, and loss of Light Perception (LP) vision.

Results

A total of 27 patients completed a 1-year follow-up period and were included in the final analysis. The mean time interval from trabeculectomy to injection of TA was 5.98 ± 2.57 weeks. The bleb height and vascularity in the IBAGS system decreased significantly after the intervention (p < 0.05), with an increase in bleb extension (p = 0.006). Using MBGS, the bleb area did not change significantly following TA injection (p = 0.056) but its height and vascularity significantly decreased in both central and peripheral areas and the surrounding conjunctiva (p = 0.032). The development of a mature cataract was the only complication that could be attributed to TA injection.

Conclusion

Injection of TA in hyperemic failing blebs improves bleb morphology by decreasing vascularity and height while increasing the extent with an acceptable safety profile.

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Availability of data and material

The data that support the findings of this study are available from the corresponding author, [SMT], upon reasonable request.

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Authors and Affiliations

  1. Glaucoma Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, Iran

    Zakieh Vahedian, Ghasem Fakhraie & Seyed Mehdi Tabatabaei

  2. Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Marzye Faraji

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Contributions

ZV and GF designed the study. MF and SMT followed the patients and were active in data registration. SMT wrote the manuscript.

Corresponding author

Correspondence to Seyed Mehdi Tabatabaei.

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Conflict of interest

Zakieh Vahedian declares that she has no conflict of interest. Ghasem Fakhraie declares that he has no conflict of interest. Marzye Faraji declares that she has no conflict of interest. Seyed Mehdi Tabatabaei declares that he has no conflict of interest.

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All procedures performed in this study which involve human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Vahedian, Z., Fakhraie, G., Faraji, M. et al. Changes in the morphology of the hyperemic blebs in eyes undergone trabeculectomy with mitomycin C after injection of triamcinolone acetonide during one-year follow-up. Int Ophthalmol 41, 3549–3557 (2021). https://doi.org/10.1007/s10792-021-01940-9

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