Sbeity Zaher, Palmiero Pat-Michael, Tello Celso, Liebmann Jeffrey M, Ritch Robert
Department of Ophthalmology, Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, NY 10003, USA.
J Glaucoma. 2009 Aug;18(6):479-83. doi: 10.1097/IJG.0b013e31818d38bf.
To evaluate the ability of a noncontact, prototype scanning laser confocal microscope to image microstructural features of filtering blebs in vivo and to correlate these with the clinical features.
Thirty-one blebs of 24 patients underwent noncontact in vivo confocal microscopy using the Rostock Cornea Module of the Heidelberg Retina Tomograph II (50x noncontact Nikon lens, 1-2 mum resolution, field of view: 500x500 mum). Blebs were clinically classified as successful (low, diffuse, microcystic, and hypovascular) (n=22, mean intraocular pressure<20 mm Hg without hypotensive medications) or failed (flat, cicatrized, and nonfiltering) (n=9, mean intraocular pressure>20 mmHg with or without hypotensive medications). Multiple transverse images were taken over the scleral flap at 1 to 2 mm from the limbus. Images were evaluated by 2 observers masked to clinical appearance and function of the bleb.
Transverse images of the successful blebs showed epithelial microcysts (50 to 100 microm) and small-sized to medium-sized (100 to 150 microm) subconjunctival cystic spaces with scattered loose collagen-like networks around the scleral flap. Failed blebs showed diffuse hyperreflective dense stroma, increased and tortuous vascularization, and no cystic spaces. The microscopic findings of all blebs were consistent with previous reports of contact in vivo confocal microscopy.
Noncontact in vivo confocal microscopy of filtering blebs correlated with the clinical morphology. This noncontact approach provides information about bleb morphology without the risk of bleb microinjury, leak, or infection. Further study and optimization for imaging surface tissues are needed to improve our understanding of bleb maturation and wound healing.
评估一款非接触式原型扫描激光共聚焦显微镜对体内滤过泡微观结构特征进行成像的能力，并将这些特征与临床特征相关联。
24例患者的31个滤过泡使用海德堡视网膜断层扫描II的罗斯托克角膜模块进行非接触式体内共聚焦显微镜检查（50倍非接触尼康镜头，分辨率1 - 2μm，视野：500×500μm）。滤过泡根据临床情况分为成功（低、弥漫、微囊性和低血管性）（n = 22，平均眼压<20 mmHg，未使用降压药物）或失败（扁平、瘢痕化和无滤过功能）（n = 9，平均眼压>20 mmHg，使用或未使用降压药物）。在距角膜缘1至2 mm处的巩膜瓣上采集多个横向图像。由2名对滤过泡临床表现和功能不知情的观察者对图像进行评估。
成功滤过泡的横向图像显示上皮微囊肿（50至100μm）以及结膜下中小尺寸（100至150μm）的囊性间隙，巩膜瓣周围有散在的疏松胶原样网络。失败的滤过泡显示弥漫性高反射致密基质、血管增生和迂曲，且无囊性间隙。所有滤过泡的微观检查结果与先前接触式体内共聚焦显微镜的报告一致。
滤过泡的非接触式体内共聚焦显微镜检查结果与临床形态相关。这种非接触方法可提供滤过泡形态信息，且无滤过泡微损伤、渗漏或感染风险。需要进一步研究和优化表面组织成像，以加深我们对滤过泡成熟和伤口愈合的理解。
