Labbé Antoine, Dupas Bénédicte, Hamard Pascale, Baudouin Christophe
Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France.
Ophthalmology. 2005 Nov;112(11):1979. doi: 10.1016/j.ophtha.2005.05.021. Epub 2005 Sep 12.
To analyze bleb structure after filtering surgery at the cellular level using a new generation in vivo confocal microscope.
Observational case series.
We retrospectively evaluated 17 filtering blebs of 13 patients after trabeculectomy.
Ophthalmologic examinations included slit-lamp examination, applanation tonometry, and in vivo confocal microscopy (Heidelberg Retina Tomograph II, Rostock Cornea Module). Eyes were classified into 3 groups: (1) functioning blebs (6 eyes), (2) nonfunctioning blebs (6 eyes), and (3) functioning blebs after application of mitomycin C (5 eyes). Cellular patterns, morphologic appearance, and functional aspects of functioning and nonfunctioning blebs were compared in a masked manner.
In vivo confocal microscopy images were analyzed for number of intraepithelial microcysts, density of subepithelial connective tissue, presence of blood vessels, or encapsulation.
All functioning blebs had numerous intraepithelial optically-empty microcysts, whereas all nonfunctioning blebs had none or few. Subepithelial connective tissue was widely spaced in all functioning blebs, whereas the tissue was dense in 83.3% of nonfunctioning blebs. Functioning blebs with mitomycin C had numerous microcysts and loosely arranged subepithelial connective tissue as compared with nonfunctioning blebs.
In vivo confocal microscopy study of blebs is an original method that agrees well with ex vivo histologic examination. The number of microcysts and the density of the subepithelial connective tissue observed with in vivo confocal microscopy are correlated with bleb function. By providing details of the structures of filtering blebs at the cellular level, in vivo confocal microscopy constitutes a new promising way to understand wound healing mechanisms after filtering surgery.
使用新一代活体共聚焦显微镜在细胞水平分析滤过性手术后的泡状结构。
观察性病例系列。
我们回顾性评估了13例患者小梁切除术后的17个滤过泡。
眼科检查包括裂隙灯检查、压平眼压测量和活体共聚焦显微镜检查（海德堡视网膜断层扫描仪II，罗斯托克角膜模块）。将眼睛分为3组：（1）功能性滤过泡（6只眼），（2）非功能性滤过泡（6只眼），（3）应用丝裂霉素C后的功能性滤过泡（5只眼）。以盲法比较功能性和非功能性滤过泡的细胞模式、形态外观和功能方面。
分析活体共聚焦显微镜图像中的上皮内微囊肿数量、上皮下结缔组织密度、血管存在情况或包囊情况。
所有功能性滤过泡均有大量上皮内光学空泡微囊肿，而所有非功能性滤过泡均无或仅有少量。所有功能性滤过泡的上皮下结缔组织间距较宽，而83.3%的非功能性滤过泡组织致密。与非功能性滤过泡相比，应用丝裂霉素C的功能性滤过泡有大量微囊肿且上皮下结缔组织排列疏松。
对滤过泡进行活体共聚焦显微镜研究是一种与离体组织学检查高度相符的原始方法。活体共聚焦显微镜观察到的微囊肿数量和上皮下结缔组织密度与滤过泡功能相关。通过在细胞水平提供滤过泡结构的详细信息，活体共聚焦显微镜构成了一种了解滤过性手术后伤口愈合机制的新的有前景的方法。
