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Abstract #13981 Published in IGR 8-3
In vivo confocal microscopy of filtering blebs after trabeculectomy
Messmer EM; Zapp DM; Mackert MJ; Thiel M; Kampik AArchives of Ophthalmology 2006; 124: 1095-1103
OBJECTIVES: To analyze filtering blebs after trabeculectomy by means of in vivo confocal microscopy and to correlate the images with clinical bleb appearance and function. METHOD: In vivo confocal microscopy using the Heidelberg Retina Tomograph/Rostock Cornea Module (Heidelberg Engineering, Heidelberg, Germany) was performed in 53 filtering blebs in 45 patients 6 days to 30 years postoperatively. RESULTS: In vivo confocal microscopic findings significantly correlated with good bleb function included the number of epithelial microcysts (P = .03), a large total stromal cyst area (P = .009), the absence of encapsulated stromal cysts (P = .002), minimal vascularization (P = .05), and the absence of tortuous conjunctival vessels (P = .01). In contrast, a hyperreflective condensed bleb stroma was significantly associated with bleb failure (P < .001). Bleb stroma mainly consisting of a rarified collagenlike network was significantly linked to trabeculectomy performed with mitomycin C (P = .001). Epithelial and stromal inflammation were observed at a median of 1 and 4 months after surgery, respectively. CONCLUSIONS: In vivo confocal microscopy using the Heidelberg Retina Tomograph/Rostock Cornea Module permits diagnostic imaging of filtering blebs and differentiation between good and insufficient bleb function. Moreover, the postoperative inflammatory reaction can be monitored directly for adapted postoperative anti-inflammatory treatment.
Dr. E.M. Messmer, Department of Ophthalmology, Ludwig-Maximilians-Universitat Munchen, Munich, Germany. emessmer@med.uni-muenchen.de
Classification:
2.1 Conjunctiva (Part of: 2 Anatomical structures in glaucoma)
6.30 Other (Part of: 6 Clinical examination methods)
12.8.1 Without tube implant (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
