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Editors Selection IGR 9-4

Surgical treatment: Fluorescein uptake by filtering blebs

Comment by Paul Palmberg on:

13039 Penetration of topically applied fluorescein into eyes with avascular filtering bleb after trabeculectomy, Matsuo H; Tomidokoro A; Araie M, American Journal of Ophthalmology, 2005; 140: 742-744

Find related abstracts

Matsuo et al. (1118) quantitatively demonstrated that the penetration of topically applied fluorescein is increased in both the peripheral cornea next to an ischemic filtering bleb and in the anterior chamber, compared to control eyes. In so doing, they have rigorously shown what had been observed casually before by glaucoma surgeons. What does this observation mean? It suggests that the barrier function for the passage of small molecules is reduced in the bleb and/or scleral wall in that region. Does it therefore suggest that some drugs would pass more readily into the anterior chamber in filtered eyes? Does the amount of fluorescein entry have a predictive value for the risk that bacteria could also pass into the anterior chamber? Seidel positive blebs have been shown to have an increased risk of infection, and it is common to observe either rapid diffusion or even bulk entry of fluorescein into such eyes, but in Seidel negative blebs is fluorescein entry related to risk? Food for thought.

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