Abdülcemal Gürpınar, Nurşen Arıtürk
Türk Oftalmoloji Dergisi - 2025;55(6):321-328
Objectives: To determine the bleb morphology and anterior segment changes after needling in trabeculectomy patients with filtration failure by anterior segment-optical coherence tomography (AS-OCT), and to identify morphological predictors of success. Materials and Methods: Thirty-two eyes of 32 patients who underwent trabeculectomy with mitomycin C and experienced filtration failure underwent bleb needling with subconjunctival 5-fluorouracil injection. AS-OCT imaging was performed before and at several time points up to 6 months post-needling. Intraocular pressure (IOP), anterior chamber depth, and bleb height and width were measured. Complete success was defined as achieving IOP <=19 mmHg without medication, and qualified success as IOP <=19 mmHg with medication at 6 months. Results: The mean age of the patients was 61.7+/-7.8 years (range, 44-76), and the mean interval between trabeculectomy and needling was 6.6+/-6.1 months (range, 1-26). IOP was 27.70+/-5.11 mmHg preoperatively (preop), 18.32+/-7.51 mmHg at 1 month, and 20.90+/-7.03 mmHg at 6 months. The decrease in IOP was statistically significant (p=0.015 and p=0.397, respectively). Bleb width was 3.74+/-0.67 mm preop, 4.16+/-0.55 mm at 1 month, and 3.9+/-0.49 mm at 6 months (p=0.001 and p=0.047, respectively). Bleb height was 0.45+/-0.16 mm preop, 0.41+/-0.11 mm at 1 month, and 0.40+/-0.11 mm at 6 months (p=0.812 and p=0.249, respectively). Conclusion: AS-OCT imaging provides an objective and reproducible evaluation of bleb morphological changes after needling. Reduced bleb height, particularly in encapsulated blebs, and increased microcyst density observed on AS-OCT predict successful aqueous humor drainage. Incorporating AS-OCT assessments into clinical practice could improve postoperative management by enabling early detection of bleb dysfunction and guiding timely interventions.
