Classification of Developing Filtering Blebs after Trabeculectomy
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.
KeywordsAqueous Humor Glaucoma Surgery Standard Photograph Scleral Flap Uveoscleral Outflow
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