title: In Vivo Goblet Cell Density as a Potential Indicator of Glaucoma Filtration Surgery Outcome.
abstract: We analyzed the preoperative conjunctival goblet cell density (GCD), MUC5AC, and HLA-DR in glaucomatous patients undergoing trabeculectomy, using laser scanning confocal microscopy (LSCM) and impression cytology (IC).
  
  
  
  We enrolled 57 patients undergoing trabeculectomy. At baseline LSCM and IC were performed at the site planned for surgery; LSCM was repeated after 12 months at the bleb site. The main outcomes were: GCD, mean microcyst density (MMD) and area (MMA) at LSCM, MUC5AC, and HLA-DR positivity at IC, and IOP. The relationships between baseline GCD, and 12-month IOP, MMD, and MMA were analyzed.
  
  
  
  Trabeculectomy was successful in 39 patients (complete success in 27, Group 1; qualified in 12, Group 2), and unsuccessful in 18 (Group 3). At baseline IOP (mm Hg) was 27.2 ± 3.12, 27.5 ± 2.23, and 27.7 ± 1.90 in Groups 1 to 3, respectively; GCD and MUC5AC positivity were higher in Group 1 compared to Groups 2 and 3 (P < 0.05); HLA-DR, MMD, and MMA were not significantly different among the groups. At 12 months, IOP reduced by 45.3%, 35.4%, and 12.8% in Groups 1 to 3, respectively. Goblet cell density did not change in Group 1, whereas it was reduced in Groups 2 and 3 (P < 0.05), with values lower in Group 3. Mean microcyst density and MMA increased in Groups 1 and 2 (P < 0.05), with values higher in Group 1 (P < 0.05). Baseline GCD positively correlated with 12-month IOP reduction (P < 0.001, r = 0.641), MMD (P < 0.05, r = 0.454), and MMA (P < 0.001, r = 0.541).
  
  
  
  Goblet cells positively affect the filtration ability after trabeculectomy; therefore, preoperative GCD could be considered as a potential in vivo biomarker of surgical success.
authors.affiliation: Ophthalmology Clinic Department of Medicine and Aging Science, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Agnifili
authors.affiliation: Ophthalmology Clinic Department of Medicine and Aging Science, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Fasanella
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.affiliation: Department of Ophthalmology, University of Siena, Siena, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Frezzotti
authors.affiliation: Excellence Eye Research Center, CeSI, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Curcio
authors.affiliation: Ophthalmology Clinic Department of Medicine and Aging Science, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
authors.forename: Lorenza
authors.initials: L
authors.lastname: Brescia
authors.affiliation: Ophthalmology Unit, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Marchini
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D002452:Cell Count; D003228:Conjunctiva / Q000473:pathology*; D003584:Cytological Techniques; D005260:Female; D018463:Filtering Surgery; D005901:Glaucoma / Q000473:pathology* / Q000601:surgery; D020397:Goblet Cells / Q000473:pathology*; D006684:HLA-DR Antigens / Q000378:metabolism; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D055271:Mucin 5AC / Q000378:metabolism; D011446:Prospective Studies; D014130:Trabeculectomy / Q000379:methods*
chemical_list: D006684:HLA-DR Antigens; C524678:MUC5AC protein, human; D055271:Mucin 5AC