Dc. Broadway et al., THE IMPORTANCE OF CELLULAR-CHANGES IN THE CONJUNCTIVA OF PATIENTS WITH UVEITIC GLAUCOMA UNDERGOING TRABECULECTOMY, Eye, 7, 1993, pp. 495-501
The results of trabeculectomy in patients with glaucoma secondary to u
veitis are poor, but the exact cause of this remains unknown. Therefor
e, a study was undertaken to determine differences between conjunctiva
from patients with glaucoma secondary to uveitis and that from patien
ts with primary open angle glaucoma. Conjunctival biopsies from three
patient groups were quantitatively analysed by light microscopy. Group
A consisted of 10 patients with glaucoma secondary to uveitis who, pr
ior to surgery, had been treated with topical steroids and topical bet
a-blocker drugs. Control groups (groups B and C) each consisted of 10
patients with primary open angle glaucoma for whom primary trabeculect
omy (group B) or trabeculectomy following failure of topical beta-bloc
kers alone (group C) was planned. Treatment with topical beta-blocker
drugs was found to redistribute mast cells within the conjunctiva but
to have no significant effect on cell numbers. In comparison with eith
er control group, uveitic conjunctiva was found to contain significant
ly more fibroblasts, lymphocytes and macrophages. It is possible that
these differences are responsible for an enhanced risk of excessive ex
ternal bleb fibrosis, failure of filtration surgery and poor results w
ith adjunctive 5-fluorouracil.