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Open Access Research article

Evaluation of filtering blebs using the ‘Wuerzburg bleb classification score’ compared to clinical findings

Sandra Furrer1, Marcel N Menke2, Jens Funk3 and Marc Töteberg-Harms34*

Author Affiliations

1 University of Zurich, Medical Faculty, Zurich, Switzerland

2 Department of Ophthalmology, Bern University Hospital, Bern, Switzerland

3 Department of Ophthalmology, UniversityHospital of Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland

4 Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA, USA

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BMC Ophthalmology 2012, 12:24  doi:10.1186/1471-2415-12-24

Published: 17 July 2012



To determine the agreement between intraocular pressure and the ‘Wuerzburg bleb classification score’, as well as between single items of the score and intraocular pressure. Interobserver variability was analyzed.


57 post-trabeculectomy eyes were included. Colour photographs were used to score the filtering bleb in accordance to the Wuerzburg bleb classification score by two different examiners. At the same visit, clinical data such as intraocular pressure, best corrected visual acuity, slit lamp biomicroscopy and medical history were obtained by another examiner.


After trabeculectomy, 42 out of 57 eyes (73.7%) reached the target pressure (≤21mmHg, and intraocular pressure reduction of at least 20%, without antiglaucoma medication, and without any additional intervention). Fair agreement was found between intraocular pressure and Wuerzburg bleb classification score ≥8 points and ≥7 points (kappa 0.24 and 0.27, respectively). Analyzing the subgroups of the morphological criteria, best agreement was found between occurrence of microcysts and target intraocular pressure (к 0.22 – 0.34).


Evaluating filtering blebs after trabeculectomy by using the Wuerzburg bleb classification score is a good technique for predicting intraocular pressure control in eyes attaining a minimum score of seven points. The presence of microcysts on the filtering bleb predicts that the eye is likely to attain target pressure.

Filtering bleb; Glaucoma; Filtration surgery; Bleb grading; Trabeculectomy