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A. Labbe, B. Dupas, P. Hamard, C. Baudouin; In vivo Confocal Microscopy Study of Blebs After Filtering Surgery . Invest. Ophthalmol. Vis. Sci. 2005;46(13):100.
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Purpose:To describe with a new in vivo confocal microscope (Corneal module of HRTII) the blebs after filtering surgery. Methods: We have evaluated retrospectively 25 filtering blebs of 22 patients after trabeculectomy or deep non–penetrating sclerectomy. Ophthalmologic examinations included slit–lamp examination, applanation tonometry and in vivo confocal microscopy imaging (Heidelberg Retina Tomograph II Rostock Cornea Module). Eyes were classified into three groups: filtering blebs (11 eyes), non–filtering blebs, either encapsulated or flat (9 eyes) and filtering blebs with mitomycin C (5 eyes). In vivo confocal microscopy images were compared to morphologic and functional aspects of filtering blebs, and in a few cases with immunohistology of removed atrophic or non–functional blebs. Results: Filtering blebs had numerous nonreflective intraepithelial microcysts, most likely composed of aqueous humor, whereas non–filtering blebs had none or very few. However, few microcysts were seen in the encapsulated filtering blebs. Connective tissue of filtering blebs was arranged loosely whereas it was dense in non–filtering blebs. Filtering blebs with mitomycin C had very numerous microcysts and loosely arranged subepithelial connective tissue. Conclusions: By evaluating filtering blebs at a cellular level, this original method is in good consistency with ex vivo histologic examination. This technique facilitates the study of epithelial tissues and peripheral structures, as compared to first–generation confocal microscopy devices. In vivo confocal microscopy constitutes a new promising way to understand wound healing mechanisms in filtering surgery.
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