Intraoperative optical coherence tomography guided bleb need
Two patients underwent bleb needling revision by using OPMI LUMERA 700 microscope (Carl Zeiss Meditec, Germany) integrated with intraoperative real time OCT (iOCT) RESCAN 700 (Carl Zeiss Meditec, Germany). The Zeiss Calisto Eye, a 22" liquid-crystal display (LCD) display screen provided an intraoperative surgical field on the left of the screen and a live OCT view on the right; the surgical and OCT video could be retrieved later. OCT uses a wavelength of 840 nm and has tissue penetration up to 2 mm. Written informed consent was obtained from both patients for recording the surgical procedures prior to surgery and the study adhered to the tenets of the Declaration of Helsinki.

Case 1

A 60-year-old man with the past surgical history of trabeculectomy in the left eye presented to us with intraocular pressure (IOP) of 32 mmHg. The patient had undergone trabeculectomy with 0.02% mitomycin C (MMC) and presented with a relatively flat and extensively vascularized bleb [Figure 1]a. Bleb needling was performed at week 10.

Case 2

A 55-year-old man with the status post of trabeculectomy and subconjunctival Ologen implant for glaucoma secondary to vitreoretinal surgery presented to us for follow-up. At 3-month postoperative visit, the bleb was encapsulated and IOP was 26 mmHg on maximal tolerable glaucoma medications.

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