The Prognostic Value of the Wuerzburg Bleb Classification Score for the Outcome of Trabeculectomy

Klink, Thomas; Kann, Gunda; Ellinger, Patrick; Klink, Janine; Grehn, Franz; Guthoff, Rainer

doi:10.1159/000314717

Cited by 25 publications

(28 citation statements)

References 36 publications

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“…It is very interesting to compare these results with those published by Klink et al . Even though they did not find any prognostic value of the early WBCS bleb score for the long-term success of TE (20% pressure reduction with reference to the pretreated IOP level and an upper IOP limit of 21 mmHg without glaucoma medication), they found that bleb score of more than 8 points in the first two weeks after TE seemed to be associated with a lower IOP (≤12 mmHg) 1 year postoperatively, while patients with a total bleb score of less than 7.0 two weeks postoperatively showed a higher IOP [25]. Our study compares the WBCS and a defined target IOP at the same time, but nonetheless we found a similar ‘cut off’ on the WBCS scale.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2012

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2012

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“…The Wuerzburg bleb classification score (WBCS) was used for standardized filtering bleb analysis at the same time as the other examinations 18. It is a grading system for clinical bleb morphology, and evaluates vascularization, corkscrew vessels, encapsulation, and microcysts 18,19. IOP was measured by Goldmann applanation tonometry after topical fluorosceine oxybuprocaine (SDU Faure, OmniVision AG, Neuhausen, Switzerland).…”

Section: Methodsmentioning

confidence: 99%

Postoperative subconjunctival bevacizumab injection as an adjunct to 5-fluorouracil in the management of scarring after trabeculectomy

Freiberg¹,

Matlach²,

Grehn³

et al. 2013

OPTH

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PurposeScarring after glaucoma filtering surgery remains the most frequent cause for bleb failure. The aim of this study was to assess if the postoperative injection of bevacizumab reduces the number of postoperative subconjunctival 5-fluorouracil (5-FU) injections. Further, the effect of bevacizumab as an adjunct to 5-FU on the intraocular pressure (IOP) outcome, bleb morphology, postoperative medications, and complications was evaluated.MethodsGlaucoma patients (N = 61) who underwent trabeculectomy with mitomycin C were analyzed retrospectively (follow-up period of 25 ± 19 months). Surgery was performed exclusively by one experienced glaucoma specialist using a standardized technique. Patients in group 1 received subconjunctival applications of 5-FU postoperatively. Patients in group 2 received 5-FU and subconjunctival injection of bevacizumab.ResultsGroup 1 had 6.4 ± 3.3 (0–15) (mean ± standard deviation and range, respectively) 5-FU injections. Group 2 had 4.0 ± 2.8 (0–12) (mean ± standard deviation and range, respectively) 5-FU injections. The added injection of bevacizumab significantly reduced the mean number of 5-FU injections by 2.4 ± 3.08 (P ≤ 0.005). There was no significantly lower IOP in group 2 when compared to group 1. A significant reduction in vascularization and in cork screw vessels could be found in both groups (P < 0.0001, 7 days to last 5-FU), yet there was no difference between the two groups at the last follow-up. Postoperative complications were significantly higher for both groups when more 5-FU injections were applied. (P = 0.008). No significant difference in best corrected visual acuity (P = 0.852) and visual field testing (P = 0.610) between preoperative to last follow-up could be found between the two groups.ConclusionThe postoperative injection of bevacizumab reduced the number of subconjunctival 5-FU injections significantly by 2.4 injections. A significant difference in postoperative IOP reduction, bleb morphology, and postoperative medication was not detected.

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“…All antiglaucomatous medication was discontinued after surgery. Patients were followed up at day 1, weeks 1 and 4, months 3, 6, and 12, and at the final follow-up visit (at a mean 24.9 ± 5.5 months for the single suture group and 23.9 ± 5.3 months for the releasable suture group), with additional visits whenever necessary, for documentation of intraocular pressure, number of intraocular pressure-lowering drugs, best corrected visual acuity, results of anterior and posterior segment examination, frequency of complications and postsurgical interventions, and filtering bleb score, ie, the Wuerzburg Bleb Classification Score (WBCS) 13. The WBCS is an objective grading system for assessment of the appearance of a filtering bleb and is used to decide whether to treat an imminent bleb scarring earlier.…”

Section: Methodsmentioning

confidence: 99%

“…Patients with a higher bleb score have better clinical morphology of the filtering bleb and a lower postoperative intraocular pressure. 13 Laser suture lysis of single sutures10–12,14 or removal of releasable sutures10,19–21 was undertaken in patients with increased intraocular pressure and flat filtering blebs which inflated after ocular massage, and in patients who did not reach their target intraocular pressure. Ocular massage immediately posterior to the scleral flap was performed to produce aqueous flow through the fistula under the conjunctiva.…”

Section: Methodsmentioning

confidence: 99%

Comparative study of trabeculectomy using single sutures versus releasable sutures

Matlach¹,

Hoffmann²,

Freiberg³

et al. 2012

OPTH

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BackgroundThe purpose of this study was to compare the outcomes of trabeculectomy using single sutures or releasable sutures.MethodsThis retrospective study analyzed the medical records of 61 patients who had undergone trabeculectomy using single sutures (n = 33, 54.1%) or releasable sutures (n = 28, 45.9%). The scleral flap was secured with a mean 3.9 (range 3–5) single sutures in 33 patients and with three releasable sutures in 28 patients. Primary outcomes were the success rate, based on intraocular pressure and medication usage, and the frequency of complications and post-surgical interventions. The criteria used to determine complete success were, first, intraocular pressure < 18 mmHg and, second, ≤21 mmHg and ≥20% intraocular pressure reduction without glaucoma medication.ResultsAll patients had an intraocular pressure ≤ 21 mmHg; 87.5% in the single suture group and 92.6% in the releasable suture group had an intraocular pressure < 18 mmHg at 24 months. There was a highly significant reduction in intraocular pressure to baseline values in both groups at the last visit. Applying the first criterion, complete success was achieved in 57.6% of patients with single sutures and 71.4% with releasable sutures, and based on the second criterion, 66.7% and 71.4%, respectively. No significant difference was found between the groups with regard to intraocular pressure, or success or complication rates.ConclusionThe results of trabeculectomy using single sutures or releasable sutures are equivalent. Therefore, the choice of suture technique should be based on individual patient requirements and surgeon experience.

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The Prognostic Value of the Wuerzburg Bleb Classification Score for the Outcome of Trabeculectomy

Cited by 25 publications

References 36 publications

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

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

Postoperative subconjunctival bevacizumab injection as an adjunct to 5-fluorouracil in the management of scarring after trabeculectomy

Comparative study of trabeculectomy using single sutures versus releasable sutures

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