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. 1994 Jun;78(6):466–475. doi: 10.1136/bjo.78.6.466

Racial differences in the results of glaucoma filtration surgery: are racial differences in the conjunctival cell profile important?

D Broadway 1, I Grierson 1, R Hitchings 1
PMCID: PMC504825  PMID: 8060931

Abstract

Conjunctival biopsies were obtained at the time of filtration surgery from 90 patients with glaucoma; 45 of these patients were black and 45 white. Forty nine of the patients (25 black, 24 white) had undergone a primary trabeculectomy. Comparisons between black and white patients were made with respect to the results of surgery and differences in conjunctival cell profile. In agreement with many authors, trabeculectomy was found to be less successful in black patients (67% compared with 80%), although this finding was not statistically significant by survival analysis. In addition, conjunctiva from black patients was found to contain a greater number of macrophages and a smaller number of both mast cells and goblet cells in comparison with white patients. There was a tendency for conjunctiva from black patients to contain more fibroblasts. Conjunctiva obtained from the patients whose filtration surgery subsequently failed was found to contain more fibroblasts, macrophages, and basal epithelial pale cells. A greater number of conjunctival macrophages and possibly fibroblasts in black patients may partially explain the tendency for a lower success rate of filtration surgery in this group of patients.

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Selected References

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  1. Abdel-Khalek L. M., Williamson J., Lee W. R. Morphological changes in the human conjunctival epithelium. I. In the normal elderly population. Br J Ophthalmol. 1978 Nov;62(11):792–799. doi: 10.1136/bjo.62.11.792. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Adala H. S., Klauss V. Causes of failure of trabeculectomy (TET) among Kenyan Africans. East Afr Med J. 1984 Mar;61(3):246–253. [PubMed] [Google Scholar]
  3. Allen R. C., Bellows A. R., Hutchinson B. T., Murphy S. D. Filtration surgery in the treatment of neovascular glaucoma. Ophthalmology. 1982 Oct;89(10):1181–1187. doi: 10.1016/s0161-6420(82)34672-2. [DOI] [PubMed] [Google Scholar]
  4. Andersen K. E., Maibach H. I. Black and white human skin differences. J Am Acad Dermatol. 1979 Sep;1(3):276–282. doi: 10.1016/s0190-9622(79)70021-1. [DOI] [PubMed] [Google Scholar]
  5. Azizkhan R. G., Azizkhan J. C., Zetter B. R., Folkman J. Mast cell heparin stimulates migration of capillary endothelial cells in vitro. J Exp Med. 1980 Oct 1;152(4):931–944. doi: 10.1084/jem.152.4.931. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Bakker N. J., Manku S. I. Trabeculectomy versus Scheie's operation: a comparative retrospective study in open-angle glaucoma in Kenyans. Br J Ophthalmol. 1979 Sep;63(9):643–645. doi: 10.1136/bjo.63.9.643. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. BenEzra D., Chirambo M. C. Trabeculectomy. Ann Ophthalmol. 1978 Aug;10(8):1101–1105. [PubMed] [Google Scholar]
  8. Berardesca E., Maibach H. I. Contact dermatitis in blacks. Dermatol Clin. 1988 Jul;6(3):363–368. [PubMed] [Google Scholar]
  9. Berardesca E., Maibach H. Cutaneous reactive hyperaemia: racial differences induced by corticoid application. Br J Dermatol. 1989 Jun;120(6):787–794. doi: 10.1111/j.1365-2133.1989.tb01376.x. [DOI] [PubMed] [Google Scholar]
  10. Berardesca E., de Rigal J., Leveque J. L., Maibach H. I. In vivo biophysical characterization of skin physiological differences in races. Dermatologica. 1991;182(2):89–93. doi: 10.1159/000247752. [DOI] [PubMed] [Google Scholar]
  11. Berson D., Zauberman H., Landau L., Blumenthal M. Filtering operations in Africans. Am J Ophthalmol. 1969 Mar;67(3):395–398. doi: 10.1016/0002-9394(69)92054-6. [DOI] [PubMed] [Google Scholar]
  12. Bryant S. M., Fukasawa M., Orita H., Rodgers K. E., diZerega G. S. Mediation of post-surgical wound healing by macrophages. Prog Clin Biol Res. 1988;266:273–290. [PubMed] [Google Scholar]
  13. Cairns J. E. Trabeculectomy. Preliminary report of a new method. Am J Ophthalmol. 1968 Oct;66(4):673–679. [PubMed] [Google Scholar]
  14. Chatterjee S., Ansari M. W. Microsurgical trabeculectomy in Ghana. Br J Ophthalmol. 1972 Oct;56(10):783–787. doi: 10.1136/bjo.56.10.783. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Cowan C. L., Jr, Worthen D. M., Mason R. P., Anduze A. L. Glaucoma in blacks. Arch Ophthalmol. 1988 Jun;106(6):738–739. doi: 10.1001/archopht.1988.01060130808027. [DOI] [PubMed] [Google Scholar]
  16. David R., Freedman J., Luntz M. H. Comparative study of Watson's and Cairns's trabeculectomies in a Black population with open angle glaucoma. Br J Ophthalmol. 1977 Feb;61(2):117–119. doi: 10.1136/bjo.61.2.117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. FRIEDENWALD J. S. Some problems in the diagnosis and treatment of glaucoma. Am J Ophthalmol. 1950 Oct;33(10):1523–1538. doi: 10.1016/0002-9394(50)91212-8. [DOI] [PubMed] [Google Scholar]
  18. Ferguson J. G., Jr, Macdonald R., Jr Trabeculectomy in blacks: a two-year follow-up. Ophthalmic Surg. 1977 Dec;8(6):41–43. [PubMed] [Google Scholar]
  19. Freedman J., Shen E., Ahrens M. Trabeculectomy in a Black American glaucoma population. Br J Ophthalmol. 1976 Aug;60(8):573–574. doi: 10.1136/bjo.60.8.573. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Gorin G. Use of a thin conjunctival flap in limbosclerectomy. Ann Ophthalmol. 1971 Mar;3(3):258–263. [PubMed] [Google Scholar]
  21. Gressel M. G., Heuer D. K., Parrish R. K., 2nd Trabeculectomy in young patients. Ophthalmology. 1984 Oct;91(10):1242–1246. doi: 10.1016/s0161-6420(84)34179-3. [DOI] [PubMed] [Google Scholar]
  22. Hatori N., Gardner J. P., Tomonari H., Fine B. P., Aviv A. Na(+)-H+ antiport activity in skin fibroblasts from blacks and whites. Hypertension. 1990 Feb;15(2):140–145. doi: 10.1161/01.hyp.15.2.140. [DOI] [PubMed] [Google Scholar]
  23. Herschler J., Litin B. S. Biochemical abnormalities in the aqueous in chronic open-angle glaucoma. Ophthalmic Surg. 1987 Nov;18(11):792–795. [PubMed] [Google Scholar]
  24. Herschler J. Medically uncontrolled glaucoma in the aphakic eye. Ann Ophthalmol. 1981 Aug;13(8):909–909. [PubMed] [Google Scholar]
  25. Heuer D. K., Gressel M. G., Parrish R. K., 2nd, Anderson D. R., Hodapp E., Palmberg P. F. Trabeculectomy in aphakic eyes. Ophthalmology. 1984 Sep;91(9):1045–1051. doi: 10.1016/s0161-6420(84)34196-3. [DOI] [PubMed] [Google Scholar]
  26. Hitchings R. A., Grierson I. Clinico pathological correlation in eyes with failed fistulizing surgery. Trans Ophthalmol Soc U K. 1983;103(Pt 1):84–88. [PubMed] [Google Scholar]
  27. Inaba Z. Long-term results of trabeculectomy in the Japanese: an analysis by life-table method. Jpn J Ophthalmol. 1982;26(4):361–373. [PubMed] [Google Scholar]
  28. Irani A. M., Schwartz L. B. Mast cell heterogeneity. Clin Exp Allergy. 1989 Mar;19(2):143–155. doi: 10.1111/j.1365-2222.1989.tb02357.x. [DOI] [PubMed] [Google Scholar]
  29. Johnston R. B., Jr Current concepts: immunology. Monocytes and macrophages. N Engl J Med. 1988 Mar 24;318(12):747–752. doi: 10.1056/NEJM198803243181205. [DOI] [PubMed] [Google Scholar]
  30. Katz L. J., Spaeth G. L. Surgical management of the secondary glaucomas: Part I. Ophthalmic Surg. 1987 Nov;18(11):826–834. [PubMed] [Google Scholar]
  31. Kelly A. P. Keloids. Dermatol Clin. 1988 Jul;6(3):413–424. [PubMed] [Google Scholar]
  32. Kietzman B. Glaucoma surgery in Nigerian eyes: a five-year study. Ophthalmic Surg. 1976 Winter;7(4):52–58. [PubMed] [Google Scholar]
  33. Kovacs E. J., Kelley J. Lymphokine regulation of macrophage-derived growth factor secretion following pulmonary injury. Am J Pathol. 1985 Nov;121(2):261–268. [PMC free article] [PubMed] [Google Scholar]
  34. Kuriyama S., Hopp L., Tamura H., Lasker N., Aviv A. A higher cellular sodium turnover rate in cultured skin fibroblasts from blacks. Hypertension. 1988 Apr;11(4):301–307. doi: 10.1161/01.hyp.11.4.301. [DOI] [PubMed] [Google Scholar]
  35. LUNTZ M. H., SMITH R. A possible aetiology for glaucoma in Negroes. Br J Ophthalmol. 1960 Oct;44:600–605. doi: 10.1136/bjo.44.10.600. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Lavin M. J., Wormald R. P., Migdal C. S., Hitchings R. A. The influence of prior therapy on the success of trabeculectomy. Arch Ophthalmol. 1990 Nov;108(11):1543–1548. doi: 10.1001/archopht.1990.01070130045027. [DOI] [PubMed] [Google Scholar]
  37. Leibovich S. J., Ross R. The role of the macrophage in wound repair. A study with hydrocortisone and antimacrophage serum. Am J Pathol. 1975 Jan;78(1):71–100. [PMC free article] [PubMed] [Google Scholar]
  38. Leibovich S. J., Wiseman D. M. Macrophages, wound repair and angiogenesis. Prog Clin Biol Res. 1988;266:131–145. [PubMed] [Google Scholar]
  39. Longstaff S., Wormald R. P., Mazover A., Hitchings R. A. Glaucoma triple procedures: efficacy of intraocular pressure control and visual outcome. Ophthalmic Surg. 1990 Nov;21(11):786–793. [PubMed] [Google Scholar]
  40. Madtes D. K., Raines E. W., Sakariassen K. S., Assoian R. K., Sporn M. B., Bell G. I., Ross R. Induction of transforming growth factor-alpha in activated human alveolar macrophages. Cell. 1988 Apr 22;53(2):285–293. doi: 10.1016/0092-8674(88)90390-x. [DOI] [PubMed] [Google Scholar]
  41. McDonald C. J. Structure and function of the skin. Are there differences between black and white skin? Dermatol Clin. 1988 Jul;6(3):343–347. [PubMed] [Google Scholar]
  42. McLaurin C. I. Cutaneous reaction patterns in blacks. Dermatol Clin. 1988 Jul;6(3):353–362. [PubMed] [Google Scholar]
  43. McMillan T. A., Stewart W. C., Hennis H. L., Hunt H. H., Apple D. J. Histologic differences in the conjunctiva of black and white glaucoma patients. Ophthalmic Surg. 1992 Nov;23(11):762–765. [PubMed] [Google Scholar]
  44. McNAIR S. S. Chronic simple glaucoma in the Negro. Am J Ophthalmol. 1951 Jan;34(1):70–76. doi: 10.1016/0002-9394(51)91929-0. [DOI] [PubMed] [Google Scholar]
  45. Merritt J. C. Filtering procedures in American blacks. Ophthalmic Surg. 1980 Feb;11(2):91–94. [PubMed] [Google Scholar]
  46. Miller M. H., Rice N. S. Trabeculectomy combined with beta irradiation for congenital glaucoma. Br J Ophthalmol. 1991 Oct;75(10):584–590. doi: 10.1136/bjo.75.10.584. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Miller R. D., Barber J. C. Trabeculectomy in black patients. Ophthalmic Surg. 1981 Jan;12(1):46–50. [PubMed] [Google Scholar]
  48. Mills K. B. Trabeculectomy: a retrospective long-term follow-up of 444 cases. Br J Ophthalmol. 1981 Nov;65(11):790–795. doi: 10.1136/bjo.65.11.790. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Montagna W., Carlisle K. The architecture of black and white facial skin. J Am Acad Dermatol. 1991 Jun;24(6 Pt 1):929–937. doi: 10.1016/0190-9622(91)70148-u. [DOI] [PubMed] [Google Scholar]
  50. Nakamura A., Gardner J., Hatori N., Nakamura M., Fine B. P., Aviv A. Differences of Ca2+ regulation in skin fibroblasts from blacks and whites. J Cell Physiol. 1989 Feb;138(2):367–374. doi: 10.1002/jcp.1041380220. [DOI] [PubMed] [Google Scholar]
  51. Pierce G. F., Mustoe T. A., Lingelbach J., Masakowski V. R., Gramates P., Deuel T. F. Transforming growth factor beta reverses the glucocorticoid-induced wound-healing deficit in rats: possible regulation in macrophages by platelet-derived growth factor. Proc Natl Acad Sci U S A. 1989 Apr;86(7):2229–2233. doi: 10.1073/pnas.86.7.2229. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Piguet P. F., Collart M. A., Grau G. E., Kapanci Y., Vassalli P. Tumor necrosis factor/cachectin plays a key role in bleomycin-induced pneumopathy and fibrosis. J Exp Med. 1989 Sep 1;170(3):655–663. doi: 10.1084/jem.170.3.655. [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Piguet P. F., Collart M. A., Grau G. E., Sappino A. P., Vassalli P. Requirement of tumour necrosis factor for development of silica-induced pulmonary fibrosis. Nature. 1990 Mar 15;344(6263):245–247. doi: 10.1038/344245a0. [DOI] [PubMed] [Google Scholar]
  54. Rappolee D. A., Mark D., Banda M. J., Werb Z. Wound macrophages express TGF-alpha and other growth factors in vivo: analysis by mRNA phenotyping. Science. 1988 Aug 5;241(4866):708–712. doi: 10.1126/science.3041594. [DOI] [PubMed] [Google Scholar]
  55. Sandford-Smith J. H. The surgical treatment of open-angle glaucoma in Nigerians. Br J Ophthalmol. 1978 May;62(5):283–286. doi: 10.1136/bjo.62.5.283. [DOI] [PMC free article] [PubMed] [Google Scholar]
  56. Sherwood M. B., Grierson I., Millar L., Hitchings R. A. Long-term morphologic effects of antiglaucoma drugs on the conjunctiva and Tenon's capsule in glaucomatous patients. Ophthalmology. 1989 Mar;96(3):327–335. doi: 10.1016/s0161-6420(89)32888-0. [DOI] [PubMed] [Google Scholar]
  57. Shingleton B. J., Distler J. A., Baker B. H. Filtration surgery in black patients: early results in a West Indian population. Ophthalmic Surg. 1987 Mar;18(3):195–199. [PubMed] [Google Scholar]
  58. Sira I. B., Ticho U. Excision of tenon's capsule in fistulizing operations on Africans. Am J Ophthalmol. 1969 Aug;68(2):336–340. doi: 10.1016/0002-9394(69)94081-1. [DOI] [PubMed] [Google Scholar]
  59. Skuta G. L., Parrish R. K., 2nd Wound healing in glaucoma filtering surgery. Surv Ophthalmol. 1987 Nov-Dec;32(3):149–170. doi: 10.1016/0039-6257(87)90091-9. [DOI] [PubMed] [Google Scholar]
  60. Stewart R. H., Kimbrough R. L., Bachh H., Allbright M. Trabeculectomy and modifications of trabeculectomy. Ophthalmic Surg. 1979 Jan;10(1):76–80. [PubMed] [Google Scholar]
  61. Thommy C. P., Bhar I. S. Trabeculectomy in Nigerian patients with open-angle glaucoma. Br J Ophthalmol. 1979 Sep;63(9):636–642. doi: 10.1136/bjo.63.9.636. [DOI] [PMC free article] [PubMed] [Google Scholar]
  62. Verrey J. D., Foster A., Wormald R., Akuamoa C. Chronic glaucoma in northern Ghana--a retrospective study of 397 patients. Eye (Lond) 1990;4(Pt 1):115–120. doi: 10.1038/eye.1990.14. [DOI] [PubMed] [Google Scholar]
  63. Wasserman S. I. Mast cell biology. J Allergy Clin Immunol. 1990 Oct;86(4 Pt 2):590–593. doi: 10.1016/s0091-6749(05)80221-0. [DOI] [PubMed] [Google Scholar]
  64. Welsh N. H. Failure of filtration operations in the African. Br J Ophthalmol. 1970 Sep;54(9):594–598. doi: 10.1136/bjo.54.9.594. [DOI] [PMC free article] [PubMed] [Google Scholar]
  65. Welsh N. H. Trabeculectomy with fistula formation in the African. Br J Ophthalmol. 1972 Jan;56(1):32–36. doi: 10.1136/bjo.56.1.32. [DOI] [PMC free article] [PubMed] [Google Scholar]
  66. Wilson M. R. Posterior lip sclerectomy vs trabeculectomy in West Indian blacks. Arch Ophthalmol. 1989 Nov;107(11):1604–1608. doi: 10.1001/archopht.1989.01070020682027. [DOI] [PubMed] [Google Scholar]

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