Evaluation of filtering blebs using the ‘Wuerzburg bleb classification score’ compared to clinical findings

Abstract

BackgroundTo determine the agreement between intraocular pressure and the ‘Wuerzburg bleb classification score’, as well as between single items of the score and intraocular pressure. Interobserver variability was analyzed.Methods57 post-trabeculectomy eyes were included. Colour photographs were used to score the filtering bleb in accordance to the Wuerzburg bleb classification score by two different examiners. At the same visit, clinical data such as intraocular pressure, best corrected visual acuity, slit lamp biomicroscopy and medical history were obtained by another examiner.ResultsAfter trabeculectomy, 42 out of 57 eyes (73.7%) reached the target pressure (≤21mmHg, and intraocular pressure reduction of at least 20%, without antiglaucoma medication, and without any additional intervention). Fair agreement was found between intraocular pressure and Wuerzburg bleb classification score ≥8 points and ≥7 points (kappa 0.24 and 0.27, respectively). Analyzing the subgroups of the morphological criteria, best agreement was found between occurrence of microcysts and target intraocular pressure (к 0.22 – 0.34).ConclusionsEvaluating filtering blebs after trabeculectomy by using the Wuerzburg bleb classification score is a good technique for predicting intraocular pressure control in eyes attaining a minimum score of seven points. The presence of microcysts on the filtering bleb predicts that the eye is likely to attain target pressure.

Changes in filtering bleb morphology after bleb-related infection

“…It was adopted for description of bleb morphology in the two independent prospective studies on bleb-related infection conducted by the Japan Glaucoma Society (JGSSBI) [12,13] and by the Collaborative Bleb Infection Incidence and Treatment Study (CBIITS) [18,19]. Several bleb-grading systems are used internationally, for example the Moorfields Bleb Grading System [20,21], the Indiana Bleb Appearance Grading System [21,22], and the Wuerzburg bleb classification score [23]. Each of these systems regards bleb morphology as closely related to the outcome of filtering surgery; the system we used focuses on the circumferential and tangential length of the bleb.…”

Fibrosis Suppression Therapy in Failed Filtering Blebs After Trabeculectomy: Results of Early Period

“…The grading scales described by Picht and Grehn, the Indiana Bleb Appearance Grading Scale (IBAGS), the Moorfields Bleb Grading System (MBGS) and Wuerzburg bleb classification score enable recording and encoding bleb appearance. 12,[31][32][33] The MBGS and the IBAGS are the most recent. We used IBAGS for scoring blebs and prescribed fibrosis suppression treatment for bleb scores under six.…”

UBM - A Tracker for Trabeculectomy

“…

Trabeculectomy is the most popular form of glaucoma filtration surgery and remains the "gold standard" for surgical reduction of Intraocular Pressure (IOP) in uncontrolled glaucoma [1]. It has a success rate of 67% to 94% [2].This partial-thickness filtration operation reduces intra ocular pressure via the creation of a limbal fistula through which aqueous humor drains into the subconjunctival space, establishing a filtering bleb.

…”

“…Yet, it also depends highly on the persistence of filtration efficiency at the bleb site. Therefore, postoperative observation and care of developing filtering bleb in clinical practice is an important tool in reaching the target pressure after filtration surgery in higher percentage of the patients [1].Bleb function is believed to depend on the degree of bleb fibrosis and obstruction of intrascleral aqueous humor flow [3]. Bleb appearance has been assessed using slit-lamp bio microscopy, gonioscopy, Ultrasound Bio Microscopy (UBM) and Optical Coherence Tomography (OCT).…”

“…Yet, it also depends highly on the persistence of filtration efficiency at the bleb site. Therefore, postoperative observation and care of developing filtering bleb in clinical practice is an important tool in reaching the target pressure after filtration surgery in higher percentage of the patients [1].…”