Aberrant wound-healing response in mitomycin C-treated leaking blebs: a histopathologic study.

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
• Journal: Archives of ophthalmology (Chicago, Ill. : 1960) (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