title: Trans-conjunctival aqueous humor outflow in glaucomatous patients treated with prostaglandin analogues: an in vivo confocal microscopy study.
abstract: OBJECTIVE
  To analyze, using in vivo laser scanning confocal microscopy (LSCM), the conjunctival features in glaucomatous patients receiving prostaglandin analogues (PGA).
  
  
  METHODS
  Eighty eyes of 80 consecutive glaucomatous patients naive for therapy were enrolled; 30 eyes of 30 healthy subjects served as a control. Patients were randomized to: preservative-free (PF) and preserved latanoprost (groups 1 and 2, respectively), PF and preserved timolol (groups 3 and 4), and controls to vehicle of latanoprost or physiological buffered saline solution (groups 5 and 6). All subjects underwent LSCM of bulbar conjunctiva at baseline and 3 months after initiating therapy. The main outcomes were: mean density (MMD: cysts/mm(2)) and mean area (MMA: cysts/mm(2)) of epithelial microcysts. The relations between MMA and MMD with intraocular pressure (IOP), age, and mean defect (MD), were analyzed.
  
  
  RESULTS
  At baseline, microcysts were found in all subjects. At month three, MMD did not change in all groups (p > 0.05). MMA significantly increased only in group 1 from 2,158.81 ± 524.09 to 3,877.77 ± 867.31, and in group 2 from 2,019.71 ± 541.03 to 5,560.39 ± 1,176.14, with values significantly higher in group 2 (p < 0.001). Significant relations were not found between MMD and MMA with IOP, MD, and age (p > 0.05).
  
  
  CONCLUSIONS
  PGA increased MMA in therapy-naive glaucomatous patients, indicating a possible enhancement of the trans-conjunctival aqueous humor outflow. Therefore, conjunctiva seems an additional target tissue to evaluate the hydrodynamic pathways in glaucoma and modifications induced by medical therapy.
authors.affiliation: Ophthalmology Unit Department of Neurological Neuropsychological Morphological and Movement Sciences, University of Verona, Verona, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Mastropasqua
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Fasanella
authors.forename: Emilio
authors.initials: E
authors.lastname: Pedrotti
authors.forename: Manuela
authors.initials: M
authors.lastname: Lanzini
authors.forename: Silvio
authors.initials: S
authors.lastname: Di Staso
authors.forename: Leonardo
authors.initials: L
authors.lastname: Mastropasqua
authors.forename: Luca
authors.initials: L
authors.lastname: Agnifili
mesh_terms: D000287:Administration, Topical; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001082:Aqueous Humor / Q000502:physiology*; D002452:Cell Count; D003228:Conjunctiva / Q000378:metabolism*; D003560:Cysts / Q000378:metabolism; D004311:Double-Blind Method; D004847:Epithelial Cells / Q000378:metabolism; D005260:Female; D005901:Glaucoma / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D000077338:Latanoprost; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D009883:Ophthalmic Solutions; D011310:Preservatives, Pharmaceutical; D011446:Prospective Studies; D011461:Prostaglandins F, Synthetic / Q000627:therapeutic use*; D013999:Timolol / Q000627:therapeutic use; D014065:Tonometry, Ocular; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000959:Antihypertensive Agents; D009883:Ophthalmic Solutions; D011310:Preservatives, Pharmaceutical; D011461:Prostaglandins F, Synthetic; D000077338:Latanoprost; D013999:Timolol