More targeted MMC application may decrease risk of leaking blebs

This study attempts to characterize the wound healing response in 40 mitomycin C-treated filtering blebs excised for persistent leaks. 

They found that 90 percent of the leaking blebs contained epithelial-stromal domes with areas of acellular stroma covered by attenuated epithelium, and 75 percent demonstrated varying degrees of fibrovascular repair growing the from the bleb margin. A novel observation noted in 65 percent was Alcian blue-positive myxoid stroma at the interface between the fibrovascular proliferations and the epithelial-stromal dome.

Their findings suggest that in order to obtain a glaucoma filtering bleb that does not leak, sufficient reparative fibrovascular response is required to maintain an epithelial-stromal barrier that prevents epithelial attenuation and leakage. 

Based on these observations, the authors recommend modifying surgical technique by primarily applying mitomycin C to treat episcleral tissue while minimizing substantia propria exposure. They believe that this change may minimize conjunctival thinning and predisposition to bleb leaks. A prospective clinical study to substantiate this hypothesis could determine if a simple modification in technique might prevent this potentially sight-threatening surgical complication. 

Financial Disclosures
Dr. Edward is a consultant to and receives lecture fees from Alcon Laboratories, Inc., and Allergan, Inc., and receives grant support from Alcon and Pfizer Ophthalmics.