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Antonio Jose Bermudez, Jordan Thompson, Sander R Dubovy, Richard K Lee, Stephanie De la O-Perez; Histopathologic Characterization of Baerveldt Glaucoma Implant Capsules in Human Eyes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3192.
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Baerveldt glaucoma drainage implants (BGI) have been used as part of the treatment for glaucoma since 1990. Despite their wide use in glaucoma practice there is little published information describing the histopathologic features of capsule formation in this specific glaucoma implant in humans. A few histopathologic case reports of Molteno, Ahmed and Baerveldt implants in the human eye have been published but no case series are available for BGI. The purpose of this case series was to provide histopathologic evidence that supports the better outcomes previously reported with the use of BGI.
Enucleated human globes from years 1996 to 2013 submitted to the Bascom Palmer Eye Institute pathology laboratory with BGI were examined. Histopathologic analysis included examination of gross specimens, as well as haematoxylin and eosin, PAS, and trichrome staining of histological sections. The capsule surrounding the BGI was assessed for cellularity, inflammation, vascularity, and capsular thickness. Capsular thinkness was measured with an optical micrometer at three different sites and the results were averaged.
A total of thirty-five eyes were received. Eighteen BGI were received attached to the globe, and Seventeen BGI were received separate from the globe for analysis. Three eyes had two BGIs. All enucleated specimens in this series were blind painful eyes or autopsy specimens associated with one of the following entities: neovascular glaucoma, endophthalmitis, uveitic glaucoma, congenital glaucoma, or indeterminate. All capsules showed mild cellularity, inflammation, and vascularity using a mild, medium, or severe grading scale. The mean capsular thickness for all specimens was 435 ± 327 microns for the inner capsule and 396 ± 187 microns for the outer capsule.
To our knowledge, this is the first series of histopathologic description of BGI in humans. In addition, this is the largest histopathologic series of any type of glaucoma drainage implants reported. BGI capsules were characterized by highly variable inner and outer capsule thickness and minimal cellularity, inflammation, and vascularity. Slightly thicker capsule is observed in other case reports for the other types of capsule. Study funded by the Florida Lions Eye Bank
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