Clinical and subclinical thickness changes, without breakdown of the blood-aqueous barrier, can be detected after cataract surgery. Most of these changes resolve spontaneously, but their mid- and long-term significance is unknown.

Comparative experimental surgery results showed excellent tolerance and efficacy in the rabbit eyes with a hyaluronic acid implant. Clinical results, to be confirmed by a randomized comparative study, also showed excellent biocompatibility and encouraging efficacy.

No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

Aims: The aim of the ab externo trabeculectomy (AET) is to remove the external portion of the trabecular meshwork (ETM) responsible for the main aqueous outflow resistance in glaucoma patients, with no opening of the anterior chamber. ETM characteristics were evaluated with a confocal microscope. Methods: A prospective comparative observational case series was performed in 60 consecutive medically treated patients with primary open angle glaucoma and eight postmortem normal donors' eyes that underwent AET. Once deroofing the Schlemm' s canal (SC), a deeper dissection led to removal of a coherent membrane (ETM) which allowed satisfactory aqueous egress through the remaining intact internal trabecular meshwork (TM) layers. After fixation with acetone and immunostaining with anti-vimentin antibody, ETM were analysed with a confocal microscope. Results: Glaucomatous ETM (mean thickness: 29.5 (7.6) µm) were characterised by a severe paucicellularity compared with the controls (respectively 37.3 (9.7) cells/area and 167.5 (24.9) cells/area, p<10 −4 ). ETM analysis showed involvement of both cribriform and corneoscleral layers. ETM cell density was significantly decreased in case of preoperative fluorometholone instillation. Conclusion: Paucicellularity of glaucomatous TM is confirmed by this original technique. Structural characteristics of the ETM, whose removal allows satisfactory aqueous egress, suggest that aqueous outflow resistance not only involves inner wall of SC and juxtacanalicular meshwork but also corneoscleral trabecular layers.

These preliminary results suggest that naproxen ophthalmic solution may be effectively and safely used to control inflammation after uneventful phacoemulsification. Because of the limited number of patients, larger studies are needed to confirm these results.