title: In vivo confocal microscopy of failing and functioning filtering blebs: Results and clinical correlations.
abstract: OBJECTIVE
  To correlate clinical filtering bleb function with characteristics as detected by in vivo confocal microscopy.
  
  
  METHODS
  In a case-matched cross-sectional study, 52 eyes of 48 patients were examined 1 day to 12.8 years after primary trabeculectomy (mean 375 d). The patients were examined clinically and by in vivo confocal microscopy (Rostock Cornea Module/Heidelberg Retina Tomograph II, Heidelberg Engineering, Inc, Heidelberg, Germany). Nine early and 17 late functioning blebs were pair-matched with malfunctioning blebs. Stromal fiber patterns, the number of intraepithelial and stromal cystic spaces, and the amount of cellular infiltrates were evaluated.
  
  
  RESULTS
  Four stromal patterns (trabecular, reticular, corrugated, compacted) invisible to slit-lamp biomicroscopy could be distinguished by in vivo confocal microscopy. The trabecular pattern occurred only in functioning blebs, particularly early postoperatively. Intraepithelial cystic spaces were associated with functioning late blebs, whereas they were equally distributed in early blebs. In contrast, stromal cystic spaces indicate function in early blebs, whereas in late blebs the number of these cavities was similar in both groups. The density of intraepithelial and stromal round cells was higher in functioning late blebs compared with malfunctioning late blebs.
  
  
  CONCLUSIONS
  In vivo confocal microscopy allows to assess filtering bleb structures that are invisible biomicroscopically. Some morphologic features detected by this technique seem to indicate filtering bleb function and time after surgery. The predictive value of these features deserves further clarification in a prospective longitudinal study.
authors.affiliation: Department of Ophthalmology, Julius-Maximilians-University Wuerzburg, Wuerzburg, Germany. r.guthoff@mail.uni-wuerzburg.de
authors.forename: Rainer
authors.initials: R
authors.lastname: Guthoff
authors.forename: Thomas
authors.initials: T
authors.lastname: Klink
authors.forename: Guenther
authors.initials: G
authors.lastname: Schlunck
authors.forename: Franz
authors.initials: F
authors.lastname: Grehn
mesh_terms: D000368:Aged; D001082:Aqueous Humor / Q000378:metabolism; D001768:Blister / Q000378:metabolism / Q000473:pathology*; D003228:Conjunctiva / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D014130:Trabeculectomy