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In vivo confocal microscopy of filtering blebs after trabeculectomy

Poster Details

First Author: C.Caglar TURKEY

Co Author(s):    N. Karpuzoglu   M. Batur   T. Yasar        

Abstract Details


The aim of this study was to analyze filtering blebs (FB) after trabeculectomy with in vivo confocal microscopy (IVCM) and biomicroscopy.


Yuzuncu Yil University, Faculty of Medicine, Ophthalmology Department, VAN


67 eyes of 55 patients were examined 12 day to 17 years after trabeculectomy (mean 3.2 years). Trabeculectomy was routinely performed with a limbus based conjunctival flap by one surgeon. The patients were examined with in vivo confocal microscopy (Rostock Cornea Module/Heidelberg Retina Tomograph III, Heidelberg, Germany) and biomicroscopy in Van Yuzuncu Yil University, Ophthalmology Clinic of Medical Faculty. While the blebs was evaluated by slit-lamp biomicroscopy, standardized FB classification was used. Statistical analysis was performed using SPSS Advanced Statistical 13.0 Software (SPSS, Chicago).One-way ANOVA test was performed to compare the means of groups with regard to variables. Duncan's test was used to determine the different groups. Pearson correlation coefficient was calculated to determine among this variables. Chi-square tes was performed to determine the relationship between groups and categorical variables.


Nine of the patients were female (16.3%) and 46 were male (83.7%), whose ages ranged from 12 to 81 (51.5±13.2) years. On biomicroscopic evaluation, the absence of vascularisation was significantly correlated with good bleb function (p=0.001). Grade 3 vascularisation was significantly correlated with poor bleb function (p=0.05). The absence of tortuos vessels on bleb was significantly correlated with good bleb function (p<0.001). Epitelial microcysts on the bleb were significantly correlated with good FB function. The absence of microcysts on bleb was not significantly correlated among groups (p=0.17). IVCM findings significantly correlated with good bleb function included the number of epithelial microcysts (P=0.002), a large total stromal cyst area (P=0.07), the absence of encapsulated stromal cysts (P=0.001), minimal vascularization (P=0.002), and the absence of tortuous conjunctival vessels (P=0.003). In contrast, a hyperreflective condensed bleb stroma was significantly associated with bleb failure (P<0.001). Bleb stroma mainly consisting of a trabecular pattern was significantly correlated trabeculectomy performed with mitomycin C (P=0.001).


The results of this study showed that IVCM and biomicroscopic classification are correlate each other to evaluate of FB after trabeculectomy. We observed that unfavorable bleb development either biomicroscopy or IVCM was characterized by increased vascularization, increased tortuosity of vessels, decreased of microcysts. The number, area and percentage rate of epithelial microcysts and stromal cyst without capsul were associated with good FB function in IVCM. In contrast, FB with condanse hiperreflective stroma was typically seen in FB with insufficient function. Our study showed that encapsulation was not correlated with bleb function in each devices. IVCM using the Heidelberg Retina Tomograph/Rostock Cornea Module permits diagnostic imaging of filtering blebs and differentiation between good and insufficient bleb function. By providing details of the structures of filtering blebs at the cellular level, IVCM constitutes a new promising way to understand wound healing mechanisms after filtering surgery. FINANCIAL INTEREST: NONE

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