In Vivo Three-Dimensional Analysis of Conjunctival Epithelial Microcysts in Glaucoma
|Silvio Di Staso1, Marco Ciancaglini1, Luca Agnifili2*, Vincenzo Fasanella2, Mario Nubile2, Rodolfo Mastropasqua3 Emilio Galassi1 and Leonardo Mastropasqua2|
|1Ophthalmology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100, Italy|
|2Ophthalmic Clinic, Department of Medicine and Aging Science, University G. d’Annunzio of Chieti-Pescara, Chieti, 66100, Italy|
|3Ophthalmology Unit, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, 37100, Verona, Italy|
|*Corresponding Author :||Luca Agnifili
114, 66100 Chieti, Italy
E-mail: [email protected]
|Received date: December 26, 2015; Accepted date: February 15, 2016; Published date: February 18, 2016|
|Citation: Di Staso S, Ciancaglini M, Agnifili L, Fasanella V, Nubile M, et al. (2016) In Vivo Three-Dimensional Analysis of Conjunctival Epithelial Microcysts in Glaucoma. J Clin Exp Ophthalmol 7:524. doi:10.4172/2155-9570.1000524|
|Copyright: © 2016 Di Staso S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
Objective: To analyze the three-dimensional (3D) features of conjunctival epithelial microcysts (CEM) in eyes affected with primary open angle glaucoma (POAG).
Methods: This was a case series study. Nine patients that underwent successful trabeculectomy and four eyes with medically controlled POAG were enrolled. Patients were examined with confocal laser-scanning microscope (Heidelberg Retina Tomograph/Rostock Cornea Module). Sequential images 300 × 300 μm (384 × 384 pixels) derived from automatic scans were acquired throughout the upper bulbar conjunctiva, 2 mm from the limbus. Image acquisition was performed in z-scan automatic volume mode and a series of 40 images to a maximum depth of 40 μm were captured. The 3-D volume tissue reconstruction with a maximal size of 300 × 300 × 40 μm and voxel size of 0.78 × 0.78 × 0.95 μm was performed with the AMIRA volume-rendering software package, to provide a 3-D characterization of conjunctival epithelial microcysts (CEM).
Results: In the enface view, CEM appeared as empty, optically clear, round or oval shaped sub-epithelial structures. In eyes that underwent trabeculectomy CEM showed greater density and larger area compared to medically controlled glaucomatous eyes. The 3-D spatial reconstruction showed microcysts as oval-shaped, optically clear, differently sized structures, often surrounded by a well-defined and mildly thick wall. All microcysts were embedded in the extra cellular spaces and located 10 μm below the epithelial surface.
Conclusions: Conjunctival epithelial microcysts were proposed as hallmark of trans-scleral aqueous humor outflow in eyes with glaucoma. They can be effectively imaged with a 3-D reconstruction system, which permits to better clarify their microscopic anatomy and patho-physiological significance.