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Objective: Analyze the application of the spectral domain optical coherence tomography (SD-OCT), Optovue iVue, on morphofunctional assessment of filtering blebs after different types of glaucoma surgery and point out the correlation between of morphologic features of blebs (bleb-wall thickness, scleral flap profile, and presence of hyporeflective spaces and internal cavity) and intraocular pressure (IOP). Methods: Thirty-eight eyes of thirty-two primarly open angle glaucoma patients, following three different types of glaucoma surgery (trabeculectomy with MMC 0.3%; with the implant of the Ex-PRESS device; with the insertion of Ologen [OLO]) were recruited. Patients attended a 6-month follow-up with intermediate checks at 1 week, 1 month and 3 months. Each visit include the evaluation of bleb using both slit lamp biomicroscopy and OCT. Results: In all patients, regardless of the type of surgery, a very significant reduction of IOP is observed after surgery. The bleb-wall thickness and the scleral flap profile are not shown to be sensitive parameters to identify the functionality of the bleb. The presence of hyporeflective spaces and of a cavity over the sclera is an important sign of bleb functionality. Among the different types of surgery, a higher percentage of blebs provided with hyporeflective spaces is in the Ex-PRESS group. In regards to the presence of a cavity over the sclera, there are no differences between the different groups. Comparing the blebs with filtering aspect at the OCT in the different groups, in the Ex-PRESS group there is a higher percentage of blebs with a filtering aspect compared to the other groups. Conclusions: Optovue iVue, is able to show detailed superficial features of the bleb which significantly correlate with the functionality of the bleb itself.

Evaluation of the conjuntival blebs using spectral domain optical coherence tomography after glaucoma surgery