To analyze the pre-operative conjunctival thickness in glaucomatous patients undergoing filtration surgery (FS), using optical coherence tomography (OCT).
The conjunctival status represents one of the most critical determinants of the FS outcome.
Retrospective study.
Sixty-seven patients candidate to FS for uncontrolled glaucoma were enrolled.
OCT was performed at the superior bulbar conjunctiva before FS, and at bleb site at the last follow-up (LF-up) after surgery.
pre-operative full, epithelial, and stromal conjunctival thickness (FCT, CET, CST) and reflectivity (CR), and LF-up bleb-wall thickness (BT), reflectivity (BR) and intra-ocular pressure (IOP), were the major outcomes. The relations between pre-operative parameters and LF-up-IOP, BT and BR were calculated.
FS was completely successful in 23 patients (Group 1), successful with medications in 22 (Group 2), and failed in 22 (Group 3). FCT, CET, and CST were lower, whereas CR higher, in Group 3 compared to Groups 1 and 2 (p<0.05); BT was lower (p<0.001), whereas BR higher (p<0.05) in Group 3 compared to Group 1. FCT and CST were predictors of FS outcome with lower thickness associated with increased odds of failure (odds ratio 0.922, p=0.08; 0.941, p=0.025). LF-up-IOP inversely correlated with FCT and CST (r=-0.447, p=0.003; r=-0.408, p=0.007), whereas positively correlated with CR (r=0.789, p<0.001).
Pre-operative conjunctival thickness and reflectivity show significant correlations with the FS outcome, both in terms of IOP and bleb-wall features. Therefore, they may be proposed as predictive imaging biomarkers to estimate the risk of filtration failure.

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