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Antonio Caimi, Mirella Blini, Mario Cigada, Giovanni Staurenghi; In Vivo Confocal Microscopy Of Filtering Blebs After Trabeculectomy With Or Without Mitomycin C. Invest. Ophthalmol. Vis. Sci. 2011;52(14):635.
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© ARVO (1962-2015); The Authors (2016-present)
To study the conjunctiva of patients affected by primary open angle glaucoma (P.O.A.G.) whit in vivo confocal microscopy (IVCM) after primary fornix based trabeculectomy with or without intraoperative mitomycin C (MMC).
We evaluated retrospectively 28 eyes (20 patients), (mean age 64,8 years, range from 40 to 80), undergone uncomplicated primary fornix based trabeculectomy performed by an experienced surgeon (M.B.). Topical preoperative therapy included beta-blockers, carbonic anhydrase inhibitors and prostaglandines. 14 eyes did (MMC group) and 14 did not (non MMC group) receive intraoperative MMC (0,3 mg/ml for 3 min) topically applied by a sponge. The evaluation consisted in a slit-lamp examination "Moorfields Bleb Grading System", applanation tonometry, color photographs, SD-OCT with AS lens, IVCM (HRT 2 with Rostock Cornea Module,Heidelberg Engineering).The examination was done at 25,4 months (mean time) after surgery, range from 2 to 79. At the time of visit, 5 of 14 eyes in the non MMC group were in therapy with beta-blockers and/or prostaglandines, no eye in the MMC group . Images were analyzed with Cornea Module Software and Image J Software by a single observer (A.C.) masked for the functionality of the bleb. We evaluated : the total area, the density, the circularity of epithelial microcysts. Statistical analysis was performed with R software using Linear regression analysis (with time of examination as covariate) and Wilcoxon rank sum test.
MMC group showed a statistically significant difference (p=0.029) for the total area of epithelial microcysts in comparison to non MMC group with an increase of 1.361 µ2 not related to time of examination (p=0.949). There wasn’t a statistically significant difference between the 2 groups for the density (p=0.349) and the circularity (p=0.928) of epithelial microcysts.
Our data suggest that MMC group present a statistically significant increase in the total area of conjuctival epithelial microcysts compared to non MMC group. Further investigations are required with a prospective longitudinal study.
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