Angiographic biomarkers of filtering bleb function after XEN gel implantation for glaucoma: an optical coherence tomography-angiography study.
Mastropasqua Rodolfo, Brescia Lorenza, Di Antonio Luca, Guarini Daniele, Giattini Dario, Zuppardi Eduardo, Agnifili Luca
AI Summary
OCT-A revealed that successful XEN blebs show more vessel displacement and less vascularity, indicating good aqueous drainage. These features are biomarkers for bleb function.
Abstract
Purpose
To evaluate, using optical coherence tomography-angiography (OCT-A), the vascular features of good bleb function after XEN gel implantation (XGI) for uncontrolled glaucoma.
Methods
Forty-three patients (43 eyes), who underwent XGI, were enrolled. According to the intraocular pressure (IOP) reduction, patients were classified into Group 1 (21 eyes; success) and Group 2 (22 eyes; failure). Optical coherence tomography-angiography (OCT-A) was performed to image the vascularization of the conjunctival bleb-wall. The main outcomes were as follows: vessel displacement areas (VDAs), major vessel displacement area (MVDA; mm 2 ), non-flow whole area (NFWA; mm 2 ) and bleb-wall vessel density (BVD; %). Co-registered B-scans were also considered to evaluate the bleb-wall cyst-like structure density and area (BCSD, cysts/mm 2 ; BCSA, mm 2 ), and the bleb-wall thickness (BT, µm).
Results
Mean postoperative follow-up was 7.5 ± 0.14 months; Group 1 and 2 IOP were 14.0 ± 2.5 and 25.3 ± 2.1 mmHg, respectively (p < 0.001). Greater VDA (p < 0.001), MVDA (p = 0.046) and NFWA (p = 0.001) values, and lower BVD (p < 0.001) was found in Group 1 compared to Group 2. Group 1 showed higher BSCD, BSCA and BT values compared to Group 2 (p < 0.001). Postoperative IOP positively correlated with BVD (r = 0.567; p = 0.003), but negatively with VDAs, MVDA (r = -0.581, p = 0.002; r = -0.619, p = 0.001, respectively), BCSD, BCSA (r = -0.580; p = 0.002; r = -0.664; p < 0.001) and BT (r = -0.627, p = 0.001).
Conclusion
Successful filtration blebs after XGI present numerous and large areas of vessel displacement within the bleb-wall, along with a rarefied vascular network. These OCT-A features can be considered angiographic biomarkers of a good aqueous humour percolation through the bleb-wall layers.
MeSH Terms
Shields Classification
Key Concepts6
Successful filtration blebs after XEN gel implantation (XGI) for uncontrolled glaucoma present numerous and large areas of vessel displacement within the bleb-wall, along with a rarefied vascular network, as observed via optical coherence tomography-angiography (OCT-A).
In patients who underwent XEN gel implantation (XGI) for uncontrolled glaucoma, successful outcomes (Group 1, n=21 eyes) showed significantly greater vessel displacement areas (VDA, p < 0.001), major vessel displacement area (MVDA, p = 0.046), and non-flow whole area (NFWA, p = 0.001) values compared to failure cases (Group 2, n=22 eyes).
In patients who underwent XEN gel implantation (XGI) for uncontrolled glaucoma, successful outcomes (Group 1, n=21 eyes) showed lower bleb-wall vessel density (BVD, p < 0.001) compared to failure cases (Group 2, n=22 eyes).
In patients who underwent XEN gel implantation (XGI) for uncontrolled glaucoma, successful outcomes (Group 1, n=21 eyes) showed higher bleb-wall cyst-like structure density (BCSD), bleb-wall cyst-like structure area (BCSA), and bleb-wall thickness (BT) values compared to failure cases (Group 2, n=22 eyes), with p < 0.001 for all three parameters.
Postoperative intraocular pressure (IOP) positively correlated with bleb-wall vessel density (BVD) (r = 0.567; p = 0.003) in patients who underwent XEN gel implantation (XGI) for uncontrolled glaucoma.
Postoperative intraocular pressure (IOP) negatively correlated with vessel displacement areas (VDAs) (r = -0.581, p = 0.002), major vessel displacement area (MVDA) (r = -0.619, p = 0.001), bleb-wall cyst-like structure density (BCSD) (r = -0.580; p = 0.002), bleb-wall cyst-like structure area (BCSA) (r = -0.664; p < 0.001), and bleb-wall thickness (BT) (r = -0.627, p = 0.001) in patients who underwent XEN gel implantation (XGI) for uncontrolled glaucoma.
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