| Abstract | OBJECTIVE: To characterize histopathologic features of leaking mitomycin C-treated blebs and aberrant wound healing that may lead to persistent conjunctival thinning and leakage. METHODS: Forty mitomycin C-treated filtering blebs excised for persistent leaks from 40 patients were examined histopathologically using hematoxylin-eosin, periodic acid-Schiff, Masson trichrome, and Alcian blue histochemical stains. RESULTS: Ninety percent of the leaking blebs contained epithelial-stromal domes with areas of acellular stroma covered by attenuated epithelium. Seventy-five percent of the blebs demonstrated varying degrees of fibrovascular repair growing from the bleb margin, either beneath or interdigitating with the acellular zone. A novel observation in 65% of specimens was Alcian blue-positive myxoid stroma at the interface between the fibrovascular proliferation and the epithelial-stromal dome. The association between the presence of fibrovascular proliferation and Alcian blue-staining myxoid stroma was significant by Fisher exact test (P = .002). CONCLUSIONS: A desirable filtration bleb requires a sufficient reparative fibrovascular response to maintain an epithelial-stromal barrier to prevent leakage. Fibroblasts must lay down a continuous collagen-rich fibrous layer, rather than merely myxoid stroma, beneath the conjunctival epithelium to promote bleb stability. Surgical techniques and postsurgical care should aim to attain this desired outcome. |
| Authors | Victor M Elner, Paula Anne Newman-Casey, A Jayaprakash Patil, Andrew Flint, Jyotirmay Biswas, Sayoko E Moroi, Vaijayanthi Pushparaj, Deepak P Edward
(Affiliation: Department of Ophthalmology & Visual Sciences, University of Michigan, Ann Arbor, USA.)
|
| Journal | Archives of ophthalmology
(Arch Ophthalmol)
Vol. 127
Issue 8
Pg. 1036-42
(Aug 2009)
ISSN: 1538-3601 [Electronic] United States |
| PMID | 19667341
(Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
|
| Chemical References |
- Antibiotics, Antineoplastic
- Mitomycin
|
| Topics |
- Antibiotics, Antineoplastic
(therapeutic use)
- Conjunctival Diseases
(drug therapy, pathology)
- Female
- Fibroblasts
(pathology)
- Fibrosis
- Glaucoma
(surgery)
- Humans
- Male
- Middle Aged
- Mitomycin
(therapeutic use)
- Surgical Flaps
(pathology)
- Trabeculectomy
- Wound Healing
|
