Anterior Segment Optical Coherence Tomography Imaging of Filtering Blebs after Deep Sclerectomy with Esnoper-Clip Implant: One-year Follow-up

Abstract

Purpose: To describe the technique of deep sclerectomy with the new Esnoper-Clip® implant, the clinical outcome and the anatomic characteristics of filtering blebs, using anterior segment optical coherence tomography (AS-OCT).Methods: A prospective case-series study was conducted in five eyes (5 patients) with open angle glaucoma. The fornix-based deep sclerectomy with Esnoper-Clip® implant was done by the same surgeon. In one case, mitomycin C was used during surgery. All participants underwent a complete ophthalmic examination and AS-OCT (Visante®) preoperatively, then at each follow-up visit, at 1 day, 1 week, 1 month, 6 months and 1 year postoperatively. Scans were obtained through sagittal and transversal plans to the implant.Results: Intraocular pressure (IOP) was significantly reduced (p < 0.05) from a mean preoperative value of 23.4 ± 8.6 mm Hg (n = 3.8 glaucoma medications) to a postoperative value of 6.0 ± 2.5 (n = 0), 10.6 ± 5.4 (n = 0), 13 ± 1.6 (n = 0.4), 12.4 ± 2.1 (n = 0.2) and 14.4 ± 1.5 (n = 0.2) at 1 day, 1 week, 1 month, 6 months and 1 year respectively. AS-OCT allowed the visualization of the two plates of the implant (scleral and suprasciliary), the trabeculodescemetic membrane and the hyporeflective spaces in the bleb wall thickness and in suprascleral and suprachoroidal localizations. An immediate postoperative hypotony and an anteriorization of the implant associated to trabeculodescemetic membrane rupture, were detected, although without significant clinical repercussions.Conclusion: Our first five deep sclerectomy with Esnoper-Clip implantation analysis suggest an effective and well-tolerated method to reduce IOP. AS-OCT is a noninvasive imaging technique that allows the anatomic analysis of the drainage mechanisms after glaucoma surgery.How to cite this article: Vieira L, Noronha M, Lemos V, Reina M, Gomes T. Anterior Segment Optical Coherence Tomography Imaging of Filtering Blebs after Deep Sclerectomy with Esnoper-Clip Implant: One-year Follow-up. J Curr Glaucoma Pract 2014;8(3):91-95.

Updates on the utility of anterior segment optical coherence tomography in the assessment of filtration blebs after glaucoma surgery

“…More recently, filtration blebs have been classified using qualitative morphological characteristics and quantitative measurements provided by AS-OCT, such as total bleb height (TBH), bleb fluid-filled cavity height (BCH) or bleb wall thickness (BWT) and number of microcysts. The importance of these parameters is that they may predict the success or failure of the surgery (Yamamoto, Sakuma & Kitazawa 1995;Savini, Zanini & Barboni 2005;Leung et al 2007;Ciancaglini et al 2008;Zhang Yi et al 2008;Kawana et al 2009;Guthoff et al 2010;Konstantopoulos et al 2013;Gomes et al 2014;P erez-Rico et al 2014;Cho et al 2015;Matsumoto et al 2016;Wen, Stinnett & Asrani 2017;Narita et al 2018;Tsutsumi-Kuroda et al 2019;Waibel et al 2019).…”

“…• SB: homogeneous looking with the presence of microcysts(Konstantopoulos et al 2013;Gomes et al 2014;P erez-Rico et al 2014) • Bleb cavity: SB versus FB: 80% versus 0%(Konstantopoulos et al. 2013) TBH • SB versus FB: NPDS 586 AE 280 lm versus 347.4 AE 237.5 lm (Konstantopoulos et al 2013) • TBC versus NPDS 699 AE 280 lm versus 418 AE 26 lm (Konstantopoulos et al 2013) Clinical relevance: higher values suggest higher probability of success (better bleb filtration) BCH • NPDS versus TBC: 102.1 AE 206.9 lm versus 347.4 AE 237.5 lm (Oh et al 2017) • SB: Regular surface and a homogeneous and hyper-reflective bleb wall.…”

“…a) Filtration bleb morphology after NPDSAs with TBC, different studies about the morphological appearance of blebs in AS-OCT images have shown that homogeneous-looking blebs with the presence of microcysts were associated with lower IOP and better functional results(Konstantopoulos et al 2013;Gomes et al 2014;P erez-Rico et al 2014). …”

Efficacy and Safety of Deep Sclerectomy With the Esnoper Clip Implant for Uncontrolled Primary Open Angle Glaucoma: A 1 Year Prospective Study

“…These devices have generally been implanted on the scleral bed, but their placement in the supraciliary space promises an effective alternative treatment for greater postoperative IOP reduction. [30][31][32][33][34] Historically, Dr Kozlov and colleagues first introduced the concept of using drainage implants in DS in 1989. 14 The first space-maintaining device developed was a purified porcine collagen AquaFlow implant (Staar Surgical AG), which was absorbed within 6-9 months.…”

Optical coherence tomography for examination of glaucoma surgery site

“…В дренажной хирургии глаукомы метод ОКТ применяют в сложных клинических случаях либо при проведении клинических исследований [66][67][68]. Необходимость в проведении ОКТ возникает при невозможности визуального контроля положения дренажной трубки в передней камере, в частности при угрозе контакта устройства с эндотелием.…”