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A Histopathologic Study

Victor M. Elner, MD, PhD; Paula Anne Newman-Casey, MD; A. Jayaprakash Patil, MD; Andrew Flint, MD; Jyotirmay Biswas, MD; Sayoko E. Moroi, MD, PhD; Vaijayanthi Pushparaj, PG DMLT; Deepak P. Edward, MD

Arch Ophthalmol. 2009;127(8):1036-1042.

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.

Author Affiliations: Departments of Ophthalmology & Visual Sciences (Drs Elner, Newman-Casey, and Moroi) and Pathology (Drs Elner and Flint), University of Michigan, Ann Arbor; Department of Ophthalmology, Summa Health System, Akron, Ohio (Drs Patil and Edward); and Larsen & Toubro Ocular Pathology Department, Sankara Nethralaya, Chennai, India (Drs Biswas and Pushparaj).

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