In vivo confocal microscopy: qualitative investigation of the conjunctival and corneal surface in open angle glaucomatous patients undergoing the XEN-Gel implant, trabeculectomy or medical therapy

作     者：Stefano Baiocchi Cosimo Mazzotta Arianna Sgheri Alessandro Di Maggio Simone Alex Bagaglia Matteo Posarelli Leonardo Ciompi Alessandro Meduri Gian Marco Tosi Stefano Baiocchi;Cosimo Mazzotta;Arianna Sgheri;Alessandro Di Maggio;Simone Alex Bagaglia;Matteo Posarelli;Leonardo Ciompi;Alessandro Meduri;Gian Marco Tosi

作者机构：Department of MedicineSurgery and NeurosciencesOphthalmology UnitPoliclinico Santa Maria alle ScotteUniversity of SienaViale Bracci 8ZIP code 53100 SienaItaly Ophthalmology UnitDepartment of Biomedical SciencesUniversity of MessinaMessinaItaly 

出 版 物：《Eye and Vision》 (眼视光学杂志（英文）)

年 卷 期：2020年第7卷第1期

页      面：136-149页

核心收录：

学科分类：1002[医学-临床医学] 100212[医学-眼科学] 10[医学] 

主　　题：Glaucoma Primary open angle glaucoma POAG MIGS Xen 45 gel stent Ocular surface Inflammation Confocal microscopy IVCM 

摘      要：Purpose:Assessing the quality of the ocular surface by in vivo scanning laser confocal microscopy(IVCM)in primary open angle glaucoma(POAG)patients treated by Xen 45 Gel Stent,medical therapy and trabeculectomy.Methods:Retrospective,single-center,single-masked,comparative study including 60 eyes of 30 patients(mean age 61.16±10 years)affected by POAG.Eyes were divided into 3 groups:Group 1 eyes underwent the Xen 45 Gel Stent procedure,Group 2 eyes were under medical therapy,Group 3 eyes were surgically treated by trabeculectomy.All patients underwent HRT II IVCM analysis of cornea,limbus,conjunctiva,sub-tenionian space and sclera.Results:The Xen 45 Gel stent,if properly positioned in the sub-conjunctival space preserves goblet cells and limits ocular surface inflammation.Regular corneal epithelial cells with micro-cysts,and normo-reflective sub-epithelial nerve plexus are documented by IVCM.In sub Tenon’s implants an alternative lamellar intra-scleral filtration is detectable.Combined surgical procedures show a noticeable number of inflammatory cells with rare micro-cysts.Post-trabeculectomy inflammatory reaction is more evident than Xen 45 Gel Stent associated surgical procedures,but less than medical therapy where a conspicuous presence of Langerhans cells,peri-neural infiltrates,marked loss of goblet cells and fibrosis is visible.Conclusion:Ocular surface inflammation was more notable in topical therapy than after trabeculectomy,which itself causes more inflammation than XEN Gel stents.