June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Bleb-related Lymphatic Outflow is Greater in Subconjunctival Compared to Subtenon Blebs.
Author Affiliations & Notes
  • Jong Yeon Lee
    Ophthalmology, Doheny Eye Institute, Los Angeles, California, United States
    Ophthalmology, Gachon University Gil Medical Center, Incheon, Incheon, Korea (the Republic of)
  • Sindhu Saraswathy
    Ophthalmology, Doheny Eye Institute, Los Angeles, California, United States
  • Goichi Akiyama
    Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan
  • Young-kwon Hong
    Department of Surgery Norris Comprehensive Cancer Center, University of Southern California Keck School of Medicine, Los Angeles, California, United States
  • Chungkwon Yoo
    Ophthalmology, Korea University, Seongbuk-gu, Seoul, Korea (the Republic of)
  • Yong Yeon Kim
    Ophthalmology, Korea University, Seongbuk-gu, Seoul, Korea (the Republic of)
  • Alex S Huang
    Ophthalmology, Doheny Eye Institute, Los Angeles, California, United States
    Ophthlamology, University of California Los Angeles, Los Angeles, California, United States
  • Footnotes
    Commercial Relationships   Jong Yeon Lee, None; Sindhu Saraswathy, None; Goichi Akiyama, None; Young-kwon Hong, None; Chungkwon Yoo, None; Yong Yeon Kim, None; Alex Huang, Aerie Pharmaceutical (C), Allergan (C), Glaukos (F), Gore (C), Heidelberg Engineering (F), Qlaris (C), Santen (C)
  • Footnotes
    Support  1) NIH EY R01EY030501 [ASH] , 2) Glaucoma Research Foundation Shaffer Grant [ASH] 3) 3) Research to Prevent Blindness Unrestricted Grant to UCLA [ASH]
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 3442. doi:
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    • Get Citation

      Jong Yeon Lee, Sindhu Saraswathy, Goichi Akiyama, Young-kwon Hong, Chungkwon Yoo, Yong Yeon Kim, Alex S Huang; Bleb-related Lymphatic Outflow is Greater in Subconjunctival Compared to Subtenon Blebs.. Invest. Ophthalmol. Vis. Sci. 2021;62(8):3442.

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Abstract

Purpose : Current glaucoma surgeries utilize stents placed in the subconjunctival or subtenon space to create blebs for eye pressure lowering. However, choice of placement has long been debated in terms of clinical benefit and biological principles. The purpose of this ex-vivo experimental study is to evaluate the subconjunctival vs. subtenon space accessibility for lymphatic outflow pathways after creation of tracer-filled blebs at each location.

Methods : Post-mortem porcine eyes received a subconjunctival (n =10) or subtenon injection (n=10) of 500kD fixable fluorescent dextran tracers. Angiographic bleb and bleb-related outflow pathway images were obtained (Spectralis HRA+OCT; Heidelberg Engineering). Bleb-related outflow pathways were counted as lymphatics only if the lumens showed valve-like structures using near simultaneous anterior segment OCT. We also compared the number of outflow pathways arising from subconjunctival and subtenon blebs in different locations (superior/inferior/temporal/nasal). As the tracers could be fixed in place, histologic analysis of the exact pathways seen on angiographic imaging was performed to confirm imaging results.

Results : Subconjunctival blebs showed a greater number of lymphatic outflow pathways compared to subtenon blebs in every quadrant. (superior, 6.10 ± 1.18 vs. 0.50 ± 0.27 [mean±SEM], temporal, 2.30 ± 0.40 vs. 0.10 ± 0.10, nasal 5.30 ± 0.60 vs. 0.30 ± 0.21, inferior, 6.00 ±1.29 vs. 0.1 ±0.1; p<0.001, p<0.001, p<0.001, p=0.001, respectively). For subconjunctival blebs, the temporal location gave rise to fewer pathways compared to nasal (p=0.005). Histological sectioning confirmed these pathways. For subtenon blebs, no quantitative difference in the number of pathways was found comparing locations. Further, histological sectioning around subtenon blebs did not demonstrate the presence of deep pathways that could have been missed on angiographic imaging owing to the increased depth.

Conclusions : Subconjunctival blebs accessed greater lymphatic outflow compared to subtenon blebs

This is a 2021 ARVO Annual Meeting abstract.

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