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Editors Selection IGR 11-3

Medical Treatment: Microcysts in OH and POAG

Malik Kahook

Comment by Malik Kahook on:

21694 Conjunctival modifications in ocular hypertension and primary open angle glaucoma: an in vivo confocal microscopy study, Ciancaglini M; Carpineto P; Agnifili L et al., Investigative Ophthalmology and Visual Science, 2008; 49: 3042-3048


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The existence of microcysts in the conjunctival epithelium (CE) of blebs in post-trabeculectomy glaucoma patients has been reported.1-3 The significance of these microcysts has been poorly understood, although they may correlate with the functional status of blebs. Ciancaglini et al. (934) present some insight into the potential link between CE microcysts and the presence of primary open-angle glaucoma (POAG) or ocular hypertension (OH). Their study utilized in-vivo confocal microscopy to examine 30 eyes with untreated OH, 96 eyes with topically treated POAG, and 15 healthy control eyes. While they found no evidence of CE microcysts in the healthy eyes examined, microcysts were found in all eyes with POAG and OH. There was no direct correlation between number/area of microcysts and other studied parameters such as age, intraocular pressure, and Humphrey 30-2 mean deviation. Glaucoma patients on unfixed combination topical therapy regimens [prostaglandin analog (PA) + timolol] did show differences in microcyst density and/or area compared to patients on monotherapy (PA or beta-blocker). The authors conclude that CE microcysts could be 'an additional potential target tissue available for investigation by a noninvasive in-vivo approach of glaucoma-induced pathologic modifications.'

With in-vivo confocal microscopy, there was no evidence of conjunctival epithelial microcysts in healthy eyes, while microcysts were found in all eyes with POAG and ocular hypertension
This manuscript explores the possibility that CE microcysts are potentially linked to 'physiopathologic mechanisms' that lead to the onset of POAG or OH. The authors hypothesize that reduced aqueous flow through the trabecular meshwork could lead to an increase in fluid movement across the sclera leading to the development of the microcysts, although little evidence exists to support this idea. Future studies will need to explore if the CE microcysts change with time in POAG/OH patients and if any temporal relationship exists to help diagnose disease. The exact effect of topical therapy (both active ingredients and preservatives) also needs to be studied further. The authors should be commended for breaking new ground in an area that is deserving of much more attention.

References

  1. Labbé A, Dupas B, Hamard P, et al. In vivo confocal microscopy study of blebs after filtering surgery. Ophthalmology. 2005 Nov;112(11):1979. Epub 2005 Sep 12.
  2. Messmer EM, Zapp DM, Mackert MJ, et al. In vivo confocal microscopy of filtering blebs after trabeculectomy. Arch Ophthalmol. 2006 Aug;124(8):1095-103.
  3. Guthoff R, Klink T, Schlunck G, et al. In vivo confocal microscopy of failing and functioning filtering blebs: Results and clinical correlations. J Glaucoma. 2006 Dec;15(6):552-8.

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