title: Conjunctival and corneal findings in bleb-associated endophthalmitis: an in vivo confocal microscopy study.
abstract: OBJECTIVE
  To report the conjunctival and corneal findings in delayed onset glaucoma filtering bleb-associated endophthalmitis (BAE), by using in vivo confocal microscopy (IVCM).
  
  
  METHODS
  This was an observational case series. Four eyes of four glaucomatous patients who previously underwent mytomicin C augmented filtering surgery and affected with delayed onset BAE, underwent IVCM of conjunctival bleb and cornea at diagnosis, after 2 and 8 weeks of therapy. The inflammatory status of the conjunctival epithelium and sub-epithelium was microscopically investigated. Corneal epithelial cells, stromal and endothelial morphology were also evaluated. A group of eight patients with functioning conjunctival filtering bleb was used as control.
  
  
  RESULTS
  At diagnosis, a diffuse inflammatory cell infiltration within the conjunctival epithelium presenting evident microcysts was found; conversely, there were no such alterations in the sub-epithelium. An evident stromal oedema, keratocytes activation and diffuse endothelial inflammatory precipitates were the major corneal hallmarks. After 2 weeks of therapy, besides a remarkable improvement of epithelial inflammation and an evident reduction in endothelial precipitates, dendritic cells appeared within conjunctival sub-epithelium and corneal epithelium showed aspects of cellular disruption. After 8 weeks, the conjunctival and corneal features consistently improved, except for the endothelium which still presented high-reflective residual precipitates.
  
  
  CONCLUSIONS
  In vivo confocal microscopy proved valuable in the analysis of conjunctival bleb and cornea in patients affected with delayed onset BAE, permitting an evaluation of the course of the disease, the response to therapy and the modulation of dose regimen.
authors.affiliation: Department of Medicine and Ageing Science, Ophthalmic Clinic, University of Chieti-Pescara, Chieti, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Carpineto
authors.forename: Luca
authors.initials: L
authors.lastname: Agnifili
authors.forename: Mario
authors.initials: M
authors.lastname: Nubile
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Fasanella
authors.forename: Emanuele
authors.initials: E
authors.lastname: Doronzo
authors.forename: Alessandra
authors.initials: A
authors.lastname: Mastropasqua
authors.forename: Marco
authors.initials: M
authors.lastname: Ciancaglini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001768:Blister / Q000175:diagnosis / Q000209:etiology; D016022:Case-Control Studies; D003231:Conjunctivitis / Q000175:diagnosis* / Q000209:etiology; D009877:Endophthalmitis / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D007634:Keratitis / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D014130:Trabeculectomy / Q000009:adverse effects*
chemical_list: D016685:Mitomycin