Bleb vessel density as a predictive factor for surgical revisions after Preserflo Microshunt implantation

Sophie Schneider; Martin Kallab; Olivia Murauer; Anna-Sophie Reisinger; Susanne Strohmaier; Alex S Huang; Matthias Bolz; Clemens A Strohmaier

doi:10.1111/aos.16642

Bleb vessel density as a predictive factor for surgical revisions after Preserflo Microshunt implantation

Acta Ophthalmol. 2024 Feb 2. doi: 10.1111/aos.16642. Online ahead of print.

Authors

Sophie Schneider¹, Martin Kallab¹, Olivia Murauer¹, Anna-Sophie Reisinger¹, Susanne Strohmaier², Alex S Huang³, Matthias Bolz¹, Clemens A Strohmaier¹

Affiliations

¹ Department of Ophthalmology and Optometry, Kepler University Hospital, Johannes Kepler University, Linz, Austria.
² Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria.
³ Hamilton Glaucoma Center, The Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, California, USA.

PMID: 38306110
DOI: 10.1111/aos.16642

Abstract

Purpose: Bleb failure is a common complication after glaucoma filtration surgery. Different bleb classification schemes incorporating filtration bleb vascularization have been proposed, but the reported correlation with intraocular pressure (IOP) has been variable, possibly because of subjective vascularization grading. The purpose of the present study was to evaluate bleb vascularization after Preserflo Microshunt (PM) implantation using anterior segment OCT-angiography (AS-OCTA) as a biomarker for bleb failure.

Methods: Twenty-three eyes of twenty-three patients underwent PM implantation. Up to 12 months after surgery PM scleral passage-centred AS-OCTA measurements (PLEX Elite 9000) for bleb-vessel density (BVD) determination were performed and IOP as well as necessity for surgical revisions (needling and open revision) were documented. After multi-step image analysis (region of interest definition, artefact removal, binarization, BVD calculation), the predictive value of early postoperative BVD for surgical revisions was assessed using logistic regression modelling.

Results: Baseline IOP (23.57 ± 7.75 mmHg) decreased significantly to 8.30 ± 2.12, 9.17 ± 2.33 and 11.70 ± 4.40 mmHg after 1, 2 and 4 week(s), and 13.48 ± 5.83, 11.87 ± 4.49, 12.30 ± 6.65, 11.87 ± 3.11 and 13.05 ± 4.12 mmHg after 2, 3, 6, 9 and 12 month(s), respectively (p < 0.001). Nine patients (39%) needed surgical revisions after a median time of 2 months. Bleb vessel densities at 2 and 4 weeks were significantly associated with future surgical revisions upon logistic regression analysis (2 W/4 W likelihood-ratio test p-value: 0.0244/0.0098; 2 W/4 W area under the receiver operating characteristics curve: 0.796/0.909).

Conclusion: Filtration bleb vessel density can be determined using AS-OCTA in the early postoperative period and is predictive for bleb failure after PM implantation.

Keywords: OCT angiography; Preserflo Microshunt; anterior segment; bleb vessel density; filtration surgery.

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