Cystoid bleb changes after cytostatics application in glaucoma surgery. Experimental study

PURPOSE: Experimental comparative analysis of hystomorphology associated with different ways of fibrosis prevention in the bleb zone after glaucoma surgery. METHODS: Experiments were conducted on rabbits with approximate weight up to 2.5 kg both male and female (12 animals, 12 eyes). In the first group the rabbits underwent penetrating deep sclerectomy (PDS) with subsequent application of mitomycin C (5 rabbits, 5 eyes). In the second group PDS was performed with Xenoplast (Transkontakt, Moscow, Russia) collagen drainage implantation under the scleral flap (5 rabbits, 5 eyes). The third or control group included 2 rabbits (4 eyes) that underwent PDS with no modifications. Follow-up period lasted for 2 months in all groups. RESULTS: Early postoperative period was characterized by the formation of high filtration blebs in all groups. Filtration surgery with mitomycin C application resulted in high thin-walled avascular bleb formation. In all rabbits of group 1 after 2 months the filtration area gradually decreased in size and lost bleb appearance, replaced by a cystoid formation corresponding with the area of previous mitomycin C application. According to histological examination, the blebs in the comparison group were filled with loose, porous tissue with a minimal amount of connective tissue cellular elements. A formation of separate vessels was noted, which was indicative of their low functional consistency. The sclera located under the filtration bleb consisted of well-defined collagen fibers, more structured than the sclera in the comparison groups, which can be attributed to the impact of drainage on the collagen fibers that constitute the mechanical basis of the scleral tissue. CONCLUSION: Cytostatics, while inhibiting the regeneration, apparently do not affect the remodulation processes. The implantation of collagen drainage containing collagen type I prevents scarring of the operation site and at the same time prolong the effect of glaucoma surgery by helping neutralize the process of eye tunic remodulation associated with the formation of thin-walled capsules impermeable to fluid.

глаукома, фильтрационная подушка, коллагеновый дренаж, митомицин C, glaucoma, filtration bleb, collagen drainage, mitomycin C

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