title: In vivo analysis of conjunctiva in canaloplasty for glaucoma.
abstract: OBJECTIVE
  To assess the epithelial features of the bulbar conjunctiva using in vivo confocal microscopy in patients with glaucoma undergoing canaloplasty.
  
  
  METHODS
  Thirty consecutive patients with glaucoma were enrolled. Canaloplasty was considered successful if the preoperative intraocular pressure (IOP) was reduced by one-third. The conjunctiva was examined using confocal laser-scanning microscopy 1 week before (baseline) and 12 weeks after surgery. The mean density (MMD, cysts/mm(2)) and mean area (MMA, μm(2)) of conjunctival microcysts and IOP were measured. Anterior segment optical coherence tomography was performed to evaluate post-operative trabecular distension and scleral modifications at the surgery site.
  
  
  RESULTS
  Twelve weeks after surgery, canaloplasty was successful in 23 patients (group 1) but unsuccessful in 7 (group 2). At baseline, IOP was 28.1±2.98 and 28.3±2.81 mm Hg, MMD was 10.61±4.31 and 11.35±5.6 and MMA was 2845.02±411.85 and 2700.56±518.85 in groups 1 and 2, respectively (p>0.05). Twelve weeks after canaloplasty, mean IOP was 13.2±4.48 (p<0.05) and 24.6±3.48 mm Hg in groups 1 and 2, respectively. In group 1, MMD and MMA were 37.86±21.4 and 11997.84±8630.35, respectively, a fourfold increase compared to baseline (p<0.001); no significant differences were found in group 2. Conjunctival bleb was not documented in any case.
  
  
  CONCLUSIONS
  Conjunctival microcysts were evident in all glaucomatous eyes prior to surgery, and tended to increase in density and surface area after successful canaloplasty. These findings indicated enhanced aqueous humour filtration across the sclera and conjunctiva after canaloplasty.
authors.affiliation: Department of Medicine and Ageing Science, Ophthalmic Clinic, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Mastropasqua
authors.forename: Luca
authors.initials: L
authors.lastname: Agnifili
authors.forename: Maria Letizia
authors.initials: ML
authors.lastname: Salvetat
authors.forename: Marco
authors.initials: M
authors.lastname: Ciancaglini
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Fasanella
authors.forename: Mario
authors.initials: M
authors.lastname: Nubile
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Mastropasqua
authors.forename: Marco
authors.initials: M
authors.lastname: Zeppieri
authors.forename: Paolo
authors.initials: P
authors.lastname: Brusini
mesh_terms: D000368:Aged; D001082:Aqueous Humor / Q000378:metabolism; D003228:Conjunctiva / Q000473:pathology*; D004847:Epithelial Cells / Q000473:pathology*; D005260:Female; D018463:Filtering Surgery; D005902:Glaucoma, Open-Angle / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D041623:Tomography, Optical Coherence; D014794:Visual Fields / Q000502:physiology