Aberrant wound-healing response in mitomycin C-treated leaking blebs: a histopathologic study.
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.
Elner
Victor M
VM
Department of Ophthalmology & Visual Sciences, University of Michigan, Ann Arbor, USA.
Newman-Casey
Paula Anne
PA
Patil
A Jayaprakash
AJ
Flint
Andrew
A
Biswas
Jyotirmay
J
Moroi
Sayoko E
SE
Pushparaj
Vaijayanthi
V
Edward
Deepak P
DP
D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D003229:Conjunctival Diseases / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005347:Fibroblasts / Q000473:pathology; D005355:Fibrosis; D005901:Glaucoma / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use*; D013524:Surgical Flaps / Q000473:pathology*; D014130:Trabeculectomy; D014945:Wound Healing
D000903:Antibiotics, Antineoplastic; D016685:Mitomycin