Classification of Developing Filtering Blebs after Trabeculectomy

  • F. Grehn
  • G. Picht
Conference paper

Abstract

The development of the filtering blebs after trabeculectomy of 55 eyes was followed to establish a classification of filtering blebs with a score system. The number of microcysts, the amount of vascularization, the appearance of “corkscrew vessels”, encapsulation, and the height of the filtering bleb were evaluated semi-quantitatively. Two groups were defined: (1) eyes with a spontaneous favorable clinical outcome, and (2) eyes that needed further postoperative interventions (5fluorouracil injections, needling, or revision). In group I, microcysts were frequent, excessive vascularization and the presence of “corkscrew vessels” were rare, encapsulation was infrequent, and the bleb was moderately elevated. In contrast, in group II, microcysts were generally absent, vascularization, “corkscrew vessels” and encapsulation were frequent, and the bleb was usually highly elevated. This behavior parallels the different activities of wound healing of the subconjunctival connective tissue. Observation of the developing filtering bleb after trabeculectomy according to standardized slit-lamp criteria may help to predict the outcome and may provide clues for the necessity of further treatment independent from postoperative intraocular pressure.

Keywords

fIltering Syringe Sponge Glaucoma Cataract 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Broadway DC, Grierson I, Hitchings R (1993) The effect of topical antiglaucomatous medications on the conjunctiva. Br J Ophthalmol 77:590–596PubMedCentralPubMedCrossRefGoogle Scholar
  2. Broadway DC, Grierson I, O’Brien C, Hitchings R (1994) Adverse effects of topical antiglaucoma medication, I: the conjunctival cell profile. Arch Ophthalmol 112:1437–1445PubMedCrossRefGoogle Scholar
  3. Costa VP, Spaeth GL, Eiferman RA, Orengo-Nania S (1993) Wound healing modulation in glaucoma filtration surgery. Ophthalmic Surg Lasers 24:152–170Google Scholar
  4. Grehn F (1990) Chirurgische Glaukomtherapie. Fortschr Ophthalmol 87[Supp1]:S175–5186PubMedGoogle Scholar
  5. Herschler J, Clafin A), Fiorentina G (1980) The effect of aqueous humor on the growth of subconjunc-tival fibroblasts in tissue culture and its implications for glaucoma surgery. Am J Ophthalmol 89:245–249Google Scholar
  6. Khaw PT, Cordeiro MF (1998) Neutralizing effects of new recombinant human TGF-132 monoclonal antibody on in vitro human conjunctival fibroblast-mediated scarring response (ARVO abstract). Invest Ophthalmol Vis Sci 39:S1107 (no 5115)Google Scholar
  7. Miller MH, Grierson I, Unger WI, Hitchings RA (1989) Wound healing in an animal model of glaucoma fistulizing surgery in the rabbit. Ophthalmic Surg 20:350–357PubMedGoogle Scholar
  8. Picht G, Grehn F (1998) Classification of filtering blebs in trabeculectomy: biomicroscopy and functionality. Curr Opin Ophthalmol 9:2–8PubMedCrossRefGoogle Scholar
  9. Picht G, Welge-Luessen U, Grehn F, Lütjen-Drecoll E (1999) Aqueous humor TGF13–2 content and total protein versus postoperative filtering bleb development in different types of glaucoma. J Glaucoma (submitted)Google Scholar
  10. Sherwood MB, Grierson I, Millar L, Hitchings RA (1989) Long-term morphological effects of anti-glaucoma drugs on the conjunctiva and Tenon’s capsule in glaucomatous eyes. Ophthalmology 96:327–335PubMedCrossRefGoogle Scholar
  11. Shingelton BJ (1996) Management of the failing glaucoma filter. Surg Rev 27:445–451Google Scholar
  12. Skuta GL, Parrish RK II (1987) Wound healing in glaucoma filtering surgery. Sury Ophthalmol 32:149–170CrossRefGoogle Scholar
  13. Tripathi RC (1994) Aqueous humor in glaucomatous eyes contains an increased level of TGF-132. Exp Eye Res 59:723–727PubMedCrossRefGoogle Scholar
  14. Vesti E (1993) Filtering blebs: follow-up of trabeculectomy. Ophthalmic Surg Lasers 24:249–255Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2000

Authors and Affiliations

  • F. Grehn
  • G. Picht

There are no affiliations available

Personalised recommendations