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Aurelia Cardon, David Bellicaud, Yannick Nochez, Philippe Sourdille, Pierre-Jean Pisella; An In Vivo Confocal Microscopy Prospective Study of Filtering Bleb Functionality. Invest. Ophthalmol. Vis. Sci. 2011;52(14):653.
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© ARVO (1962-2015); The Authors (2016-present)
To improve filtering surgery results evaluation by means of in vivo confocal microscopy (IVCM).
We evaluated 38 filtering blebs (29 patients) which underwent filtering surgery for glaucoma with a mean follow-up time of 16.4 ± 8.4 months. Examination included clinical slit-lamp examination, intraocular pressure (IOP) measurement and IVCM assessment. Filtering blebs were classified in 3 functional clinical groups according to the final IOP. IVCM on the filtering bleb was performed with HRT2 confocal microscope corneal module (Rostock Cornea Module®, Heidelberg Engineering, Germany). Group 1 patient were reexamined 12 months after the initial evaluation to determine possible changes. Statistical analysis was done with Student’s t-test, Wilcoxon, Fisher and Anova tests.
23 eyes were group 1 (IOP under 17mmHg without medication), 9 eyes were group 2 (IOP under 17mmHg with medication) and 6 eyes were group 3 (IOP over 17mmHg despite medication). Success microscopic criteria were a high microcysts density (p=0.0002), a large total microcysts area (p=0.0012) and a thick microcysts layer (p=0.04). To the contrary of successful blebs, failed blebs (group 3) presented with a low density of microcysts (p=0.0035). Moreover microcysts density was correlated negatively to final IOP (r²=0.23 with p=0.002). Group 1 patients reexamined after one year had clinically (slitlamp aspect, IOP) functional filtering blebs and a stable microcysts density. However significant microscopic architecture modifications were observed after a one-year follow-up.
IVCM provides a precise imaging of filtering blebs at a microscopic level. Microcysts density is a valuable microscopic criteria of good clinical functionality. Based on our study IVCM seems to be the only method to detect infraclinical changes potentially influencing bleb functionality.
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