Article Text

Download PDFPDF
Original article
In vivo analysis of conjunctiva in canaloplasty for glaucoma
  1. Leonardo Mastropasqua1,
  2. Luca Agnifili1,
  3. Maria Letizia Salvetat2,
  4. Marco Ciancaglini3,
  5. Vincenzo Fasanella1,
  6. Mario Nubile1,
  7. Rodolfo Mastropasqua1,
  8. Marco Zeppieri2,
  9. Paolo Brusini2
  1. 1Department of Medicine and Ageing Science, Ophthalmic Clinic, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
  2. 2Department of Ophthalmology, S. Maria della Misercordia Hospital, Udine, Udine, Italy
  3. 3Department of Surgical Sciences, Ophthalmic Clinic, University of L'Aquila, L'Aquila, Italy
  1. Correspondence to Luca Agnifili, Via dei Frentani, 114, 66100 Chieti, Italy; l.agnifili{at}


Aim To assess the epithelial features of the bulbar conjunctiva using in vivo confocal microscopy in patients with glaucoma undergoing canaloplasty.

Methods Thirty consecutive patients with glaucoma were enrolled. Canaloplasty was considered successful if the preoperative intraocular pressure (IOP) was reduced by one-third. The conjunctiva was examined using confocal laser-scanning microscopy 1 week before (baseline) and 12 weeks after surgery. The mean density (MMD, cysts/mm2) and mean area (MMA, μm2) of conjunctival microcysts and IOP were measured. Anterior segment optical coherence tomography was performed to evaluate post-operative trabecular distension and scleral modifications at the surgery site.

Results Twelve weeks after surgery, canaloplasty was successful in 23 patients (group 1) but unsuccessful in 7 (group 2). At baseline, IOP was 28.1±2.98 and 28.3±2.81 mm Hg, MMD was 10.61±4.31 and 11.35±5.6 and MMA was 2845.02±411.85 and 2700.56±518.85 in groups 1 and 2, respectively (p>0.05). Twelve weeks after canaloplasty, mean IOP was 13.2±4.48 (p<0.05) and 24.6±3.48 mm Hg in groups 1 and 2, respectively. In group 1, MMD and MMA were 37.86±21.4 and 11997.84±8630.35, respectively, a fourfold increase compared to baseline (p<0.001); no significant differences were found in group 2. Conjunctival bleb was not documented in any case.

Conclusions Conjunctival microcysts were evident in all glaucomatous eyes prior to surgery, and tended to increase in density and surface area after successful canaloplasty. These findings indicated enhanced aqueous humour filtration across the sclera and conjunctiva after canaloplasty.

  • Canaloplasty
  • primary open angle glaucoma
  • bleb-less surgery
  • in vivo confocal microscopy
  • conjunctival microcysts
  • trans-scleral outflow
  • diagnostic tests/investigation
  • aqueous humour
  • conjunctiva
  • glaucoma
  • imaging
  • treatment surgery
  • treatment medical
  • pathology
  • sclera and episclera
  • optic nerve
  • drugs
  • intraocular pressure
  • angle
  • treatment lasers
  • inflammation
  • wound healing
  • cornea
  • stem cells
  • treatment medical
  • field of vision
  • optic nerve
  • intraocular pressure
  • psychophysics

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Linked Articles

  • At a glance
    Harminder Singh Dua Arun D Singh