title: Lymphatic and Blood Vessel Density in Human Conjunctiva After Glaucoma Filtration Surgery.
abstract: OBJECTIVE
  To investigate the lymphatic vascular microvessel density (LVD) and the blood vascular microvessel density (MVD) and their distribution in excised leaking blebs after mitomycin C trabeculectomy and normal conjunctiva specimens.
  
  
  METHODS
  LVD and MVD in normal human conjunctiva (n=8) and excised blebs in the hypocellular stroma and peribleb tissue (conjunctiva adjacent to hypocellular bleb tissue) (n=8) were evaluated by immunohistochemistry using antibodies raised against Lymphatic Vessel Endothelial Receptor 1 (D2-40, lymphatic endothelium) and CD34 (vascular endothelium). LVD and MVD counts were performed by light microscopy in 5 fields at ×20 magnification by 3 observers. Differences were determined using Mann-Whitney U test (P<0.05 was considered significant).
  
  
  RESULTS
  The leaking blebs showed typical epithelial-stromal domes with areas of acellular stroma covered by attenuated epithelium and surrounded by normal conjunctival epithelium and a dense scar-like matrix replacing the substantia propria. The LVD and MVD were significantly reduced to nil in the hypocellular conjunctival stroma of the excised blebs compared with normal conjunctiva (21.42 vs. 1.16, P<0.002 and 24.28 vs. 1, P<0.008, respectively). The LVD and MVD was also reduced (2- to 2.5-fold) in the peribleb stroma when compared with normal conjunctiva specimens.
  
  
  CONCLUSIONS
  In this study we show reduced LCD and MVD in the hypocellular and peribleb stroma. These results may suggest a role of these vessels in an altered immune response in leaking blebs leading to an increased risk for blebitis.
authors.affiliation: *Summa Health System, Akron, OH †King Khaled Eye Specialist Hospital, Riyadh, KSA ‡Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD.
authors.forename: Rachida A
authors.initials: RA
authors.lastname: Bouhenni
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Al Jadaan
authors.forename: Heidi
authors.initials: H
authors.lastname: Rassavong
authors.forename: Sami
authors.initials: S
authors.lastname: Al Shahwan
authors.forename: Hind
authors.initials: H
authors.lastname: Al Katan
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Dunmire
authors.forename: Mirela
authors.initials: M
authors.lastname: Krasniqi
authors.forename: Deepak P
authors.initials: DP
authors.lastname: Edward
mesh_terms: D000328:Adult; D000368:Aged; D000477:Alkylating Agents / Q000008:administration & dosage; D058846:Antibodies, Monoclonal, Murine-Derived / Q000378:metabolism; D018952:Antigens, CD34 / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D001808:Blood Vessels / Q000378:metabolism / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003228:Conjunctiva / Q000098:blood supply*; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D015812:Glaucoma, Angle-Closure / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006871:Hydrophthalmos / Q000503:physiopathology / Q000601:surgery*; D007150:Immunohistochemistry; D007429:Intraocular Pressure / Q000502:physiology; D042601:Lymphatic Vessels / Q000378:metabolism / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D014130:Trabeculectomy
chemical_list: D000477:Alkylating Agents; D058846:Antibodies, Monoclonal, Murine-Derived; D018952:Antigens, CD34; D015415:Biomarkers; C500987:monoclonal antibody D2-40; D016685:Mitomycin