Novel Tomographical Bleb Classification Following ab-interno Implantation of Gel-Stent Using Anterior Segment Optical Coherence Tomography.

Hasan, Somar M; Theilig, Theresa; Tarhan, Melih; Papadimitriou, Menelaos; Unterlauft, Jan Darius; Meller, Daniel (2023). Novel Tomographical Bleb Classification Following ab-interno Implantation of Gel-Stent Using Anterior Segment Optical Coherence Tomography. Journal of glaucoma, 32(2), pp. 117-126. Lippincott Williams & Wilkins 10.1097/IJG.0000000000002096

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PRCIS

A novel qualitative tomographical classification for bleb following implantation of XEN-Gel-Stent using ab-interno approach is presented. Association of anatomical patterns to IOP and success rates illustrates that AS-OCT can be useful tool in clinical guidance.

PURPOSE

To present a novel classification of bleb resulting from ab-interno implantation of XEN-Gel-Stent and report association of tomographical patterns with intraocular pressure (IOP) and success rates (SR).

MATERIALS AND METHODS

A cross-sectional one-armed study of patients receiving XEN-Gel-Stent. Tomographical changes in the bleb area were studied using swept-source optical coherence tomography in an early (day 29 to 90 post-surgery) and late (starting from day 91 post-surgery) phase. Frequency of patterns and their association with IOP and SR (defined as IOP<18 mmHg without medications) were studied.

RESULTS

111 examinations of 49 blebs (49 patients) were included. 3 tomographical patterns at conjunctival, 4 at tenons capsule and 2 at episcleral level were characterized. Most frequent conjunctival pattern was subepithelial spaces (56.3% and 53.2%in the early and late phase, respectively) and associated with lower IOP (13.0±6.0 mmHg) and higher SR (89%) but only in the early phase compared to other conjunctival patterns (P<0.05). At tenons capsule level, the hyporeflective pattern was most frequent (50% and 51.9% in early and late phase) followed by the cavernous pattern. Both patterns associated with lower IOP and higher SR compared to hyperreflective or loss of tenon changes (P<0.005). Most blebs showed no episcleral lake (87.5% and 89.9% in early and late phase). No difference of IOP and SR was noted compared to those showing an episcleral lake.

CONCLUSION

A practical and clinically relevant novel classification system is proposed to tomographically describe and classify blebs following implantation of XEN-Gel-Stent. Certain patterns were associated with lower IOP and higher SR.

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