TY - JOUR
T1 - Noncontact in vivo scanning laser microscopy of filtering blebs
AU - Sbeity, Zaher
AU - Palmiero, Pat Michael
AU - Tello, Celso
AU - Liebmann, Jeffrey M.
AU - Ritch, Robert
PY - 2009/8
Y1 - 2009/8
N2 - Purpose: 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. Methods: Thirty-one blebs of 24 patients underwent noncontact in vivo confocal microscopy using the Rostock Cornea Module of the Heidelberg Retina Tomograph II (50× noncontact Nikon lens, 1-2μm resolution, field of view: 500×500μm). 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>20mmHg with or without hypotensive medications). Multiple transverse images were taken over the scleral flap at 1 to 2mm from the limbus. Images were evaluated by 2 observers masked to clinical appearance and function of the bleb. Results: Transverse images of the successful blebs showed epithelial microcysts (50 to 100μm) and small-sized to medium-sized (100 to 150μm) 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. Conclusions: 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.
AB - Purpose: 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. Methods: Thirty-one blebs of 24 patients underwent noncontact in vivo confocal microscopy using the Rostock Cornea Module of the Heidelberg Retina Tomograph II (50× noncontact Nikon lens, 1-2μm resolution, field of view: 500×500μm). 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>20mmHg with or without hypotensive medications). Multiple transverse images were taken over the scleral flap at 1 to 2mm from the limbus. Images were evaluated by 2 observers masked to clinical appearance and function of the bleb. Results: Transverse images of the successful blebs showed epithelial microcysts (50 to 100μm) and small-sized to medium-sized (100 to 150μm) 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. Conclusions: 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.
KW - Blebs
KW - Confocal laser scanning microscopy
KW - Noncontact lens
UR - http://www.scopus.com/inward/record.url?scp=70249106768&partnerID=8YFLogxK
U2 - 10.1097/IJG.0b013e31818d38bf
DO - 10.1097/IJG.0b013e31818d38bf
M3 - Article
C2 - 19680057
AN - SCOPUS:70249106768
SN - 1057-0829
VL - 18
SP - 479
EP - 483
JO - Journal of Glaucoma
JF - Journal of Glaucoma
IS - 6
ER -