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A case of developmental glaucoma presenting with abdominal colic and subnormal intraocular pressure.

A healthy baby boy presented with abdominal colic. He was subsequently noted to have enlarged, edematous corneas. A clinical diagnosis of developmental glaucoma was made despite ocular hypotony. Trabeculectomies were designed to include peripheral cornea. This served as a biopsy to confirm the diagnosis and as a surgical treatment for the condition. Morphological examination of the outflow system revealed findings compatible with a diagnosis of developmental glaucoma: a hypoplastic trabecular meshwork which contained an abundance of abnormal collagenous tissue in the extracellular spaces and the presence of endothelial cells overlying a continuous collagenous membrane. In the iris stroma there were numerous abnormal blood vessels, with a paucity of mural contractile cells.

Colic↗

Pigment dispersion syndrome and pigmentary glaucoma.

The pigment dispersion syndrome is a relatively uncommon condition, occurring as a result of pigment loss from the posterior-pigmented epithelium of the iris, with subsequent redeposition of the pigment throughout the anterior chamber. Obstruction of the trabecular meshwork occasionally leads to pigmentary glaucoma, with increased intraocular pressure, optic nerve head changes, and visual field loss. We present two cases of pigmentary dispersion syndrome, one of which progressed to pigmentary glaucoma with the eventual need for laser trabeculoplasty.

Adult↗

Trabecular cell expression of fibronectin and MMP-3 is modulated by aqueous humor growth factors.

We investigated the mRNA and protein expression of fibronectin and stromelysin-1 (matrix metalloproteinase-3, MMP-3) by trabecular cells treated with growth factors present in primary and secondary aqueous humors. Serum-deprived trabecular cells were incubated for 48 hr or 7 days in medium containing either primary or secondary aqueous humor growth factors or in serum-free medium. We extracted total RNA, performed reverse transcription-polymerase chain reaction using primer pairs for fibronectin, stromelysin-1 and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and quantified the products. We utilized Western blotting to detect and quantify fibronectin and stromelysin-1 protein. Compared to controls, expression of fibronectin mRNA by trabecular cells was increased by 50 and 100% after incubation in primary aqueous humor growth factors for 48 hr or 7 days, respectively, and 50 and 130% after incubation in secondary aqueous humor growth factors. Stromelysin-1 mRNA expression was decreased by 25 and 50% after incubation in primary aqueous humor growth factors for 48 hr or 7 days, respectively, and 80 and 85% after incubation for 48 hr or 7 days, respectively, in secondary aqueous humor growth factors. Fibronectin protein increased 3.5-fold and 6-fold after incubation for 48 hr with primary or secondary aqueous humor growth factors, respectively; after 7 days, the level increased 4- and 7-folds, respectively. Stromelysin-1 protein was not detectable by western blotting. The up-regulation of fibronectin mRNA by trabecular cells exposed to growth factors present in secondary aqueous humor augmented by the down-regulation of stromelysin-1 mRNA contributed to the accumulation of fibronectin. Our findings open the possibility that induction of stromelysin-1 gene expression in the trabecular meshwork of glaucomatous eyes could effectively reduce buildup of fibronectin in the aqueous outflow pathway to decrease outflow resistance in glaucomatous states of the eye.

Animals↗

Acute angle-closure glaucoma precipitated by local tiotropium absorption.

Acute angle-closure glaucoma is a rare form of glaucoma occurring when the filtration mechanism for the aqueous humor is obstructed by apposition of the peripheral iris to the trabecular meshwork. It may be precipitated by pupillary dilatation in a predisposed eye. In this case report, a possible relationship between local tiotropium absorption and acute angle-closure glaucoma attack is presented.

Absorption↗

The trabecular mesh: a mathematical analysis.

The corneoscleral trabecular meshwork is a three-dimensional net of diagonally crossing collagenous fiber invested in endothelium. Tension on the mesh should cause it to tend to bow inward and hold Schlemm's canal open. Inward bowing is restrained by attachment of the outer mesh to the corneosclera, by meridional uveal mesh fibers, and by resistance to mesh element crossing to deformation. A lamella of meshwork is analyzed from a geometrical point of view, and it is found that even were the mesh free to assume an inward bowed hyperboloidal shape, the spur movement required to change mesh configuration from that of a cone frustum to hyperboloid would be only 0.047 mm and not readily recognizable gonioscopically.

Collagen↗

Long-term control of adult open angle glaucoma by argon laser treatment.

Uncontrolled adult open angle glaucoma was treated with a new argon laser technique in which 100 spots are applied 360 degrees around the trabecular meshwork. The average pressure drop was 12.7 mm Hg in 105 eyes at one year, 11.5 mm Hg in 59 eyes at two years, 11.3 mm Hg in 25 eyes at three years, and 13.3 mm Hg in 11 eyes at four years. Only 6% of the eyes required additional surgery. The rate of control was equivalent to trabeculectomy, but with far fewer complications. Control in blacks and in patients over age 70 was better (91%) than with surgical procedures. Microscopic examination of two controlled eyes showed no trabecular punctures. The laser microscars reduce the diameter of the trabecular ring, tightening the meshwork, and restoring function to the normal outflow systems.

Adult↗

Neodymium:YAG laser iridotomy in the cynomolgus monkey.

The histologic effects of various Neodymium:YAG laser energy levels were evaluated after iridotomy formation in cynomolgus monkey eyes. Scanning election microscopy of the corneal endothelium above the treated areas revealed no significant cell loss or pleomorphism when compared to the adjacent untreated areas. Light and phase contrast microscopy demonstrated closure of the iridotomies in most cases by a bridge of iris pigment epithelium. In several specimens, stromal tissue and pigment laden cells were present over the attenuated iris pigment epithelium. There were four lens opacities with rupture of the anterior lens capsule and anterior epithelial cell hyperplasia in one. No damage was apparent in the trabecular meshwork or retina with light microscopy or fluorescein angiography.

Animals↗

The effect of experimental glaucoma on vitreous volume.

Long-term unilateral blocking of the trabecular meshwork with Dextran blue 2000, in 10 rabbits, produced intraocular pressure rise and a significant gain in vitreous mass. These experimental findings were in variance with the previous clinical observation of definitely reduced vitreous volume in phacolytic glaucomatous patients. The reason for this discrepancy is discussed.

Animals↗

Pigmentary dispersion glaucoma secondary to posterior chamber intra-ocular lenses.

Thirteen cases of pigmentary dispersion glaucoma are presented. These had in common heavy pigment granule deposition in the trabecular meshwork in the operated eye alone, a history of posterior chamber intra-ocular lens implantation, and mild to marked iris pigment atrophy in areas contingent with or adjacent to the lens. High intra-ocular pressures were usually transient and easily controlled. One, however, eventually required trabeculoplasty.

Aged↗

Scanning electron microscopy of trabeculectomy specimens in open-angle glaucoma.

We examined trabeculectomy specimens obtained at the time of surgery for inadequately controlled open-angle glaucoma by scanning electron microscopy. Of the 50 specimens ten included a broad area of the trabecular meshwork. In these ten specimens the meshwork was obscured by material. We believe the degree of occlusion was significant in these specimens, which would lead to obstruction of aqueous outflow. No similar material was found in control specimens from persons of similar age.

Aged↗

Open-angle glaucoma associated with posterior polymorphous dystrophy. A clinicopathologic study.

Clinical and histopathologic features of a 62-year-old black man with posterior polymorphous dystrophy and open-angle glaucoma requiring trabeculectomy are reported. The surgical procedure was modified to allow en bloc resection of the deep limbal tissue and peripheral iris. Light and electron microscopy of the specimen revealed a high insertion of the iris into the posterior portion of the trabecular meshwork with compression of the intertrabecular spaces. These findings are similar to changes that have been reported in primary congenital glaucoma and suggest a developmental anomaly of the anterior chamber angle in this form of glaucoma associated with posterior polymorphous dystrophy.

Cornea↗

[Calf trabecular cell culture in vitro, morphological and cytoskeletal ultrastructures and kinetics investigation].

OBJECTIVE: To establish the method of culturing calf trabecular cells (CTCs) in vitro, to understand the morphology and function of CTCs, to probe into the effect of resistance of aqueous outflow in the pathogenesis and mechanism about primary open angle glaucoma(POAG). To direct the clinical using of drugs and to open up new antiglaucomatous medicine by pharmacological studies of CTCs. METHODS: Trabecular meshwork was collected from twenty eyeballs of calf donors after slaughter. The tiusse was primarily cultured and cells were subcultured. The growing characteritics and morphological features of cultured primary and passaged cells were observed by light and electron microscopes. Cell kinetics of the third and tenth passaged cells were analysed using autoradiography and flow cytometry. The influence of the antiglaucomatous drugs 0.25 mg.ml-1 epinephrine (EPI) and 0.025 mg.ml-1 dipivalyl epinephrine (DPE) on cell kinetics of the third passaged cells was studied. RESULTS: The growing characteritics and morphological features of cultured CTCs were as same as those of human trabecular cells. Growing types of CTCs included most of epitheial cell and few of fibroblast. The amount of cellular microfilaments was reduced, DNA synthesis time(Ts) and cell cycle time(Tc) were obviously prolonged with passaged increasing. Antiglaucomatous drugs-EPI (0.25 mg.ml-1) and DPE (0.025 mg.ml-1) made microfilaments dissolving, Ts and Tc obviously prolonging. CONCLUSION: Establishing the method of culturing CTCs in vitro and understanding their morphology, function and pharmacological effects provided an important information for studying human trabecular cells and probing into the effect of resistance of aqueous outflow in the pathogenesis and mechanism about POAG. These studies indicated that antiglaucomatous drugs-EPI (0.25 mg.ml-1) and DPE (0.025 mg.ml-1) influenced obviously microfilaments and cell kinetics of the third passaged cells and suggested that it is not to be ignored that 1% EPI and 0.1% DPE may make CTCs' microfilaments dissolving and may inhibit CTCs' division and proliferation when they are used in clinical therapy.

Actin Cytoskeleton↗

[Demonstration of the tonographic effect in YAG laser trabeculoplasty in chronic glaucoma].

In a pilot study comprising 16 eyes of 16 patients with chronic open-angle glaucoma the tonographic outflow facility was examined before and after Nd-YAG laser treatment of the trabecular meshwork. For evaluation of the facility effect of laser trabeculoplasty, the tonographic record between the third and seventh minute according to the tonography test of Leydhecker was used. An improvement in outflow facility was established which correlated with the postoperative fall in IOP.

Follow-Up Studies↗

Intraocular pressure changes after phacoemulsification and foldable silicone lens implantation using Healon GV.

The authors studied the intraocular pressure (IOP) changes after phacoemulsification with two different kinds of foldable silicone lens implantation using Healon GV as viscoelastic substance. One hundred patients undergoing cataract surgery were enrolled in this study. Inclusion criteria were: absence of ocular hypertension or glaucoma. Patients were randomly assigned to plate haptic (Silens PH, Domilens Chiron Vision, Lyon, France) or three-piece (CeeOntrade mark& ;920, Pharmacia spa, Milano, Italia) silicone intraocular lens (IOL) implantation. Following phacoemulsification and cortical aspiration, the capsular bag was reinflated with Healon GV. After foldable silicone IOL insertion residual Healon GV was removed from the anterior chamber. IOP was measured preoperatively and at 6, 24 h and 1 week postoperatively. Six hours postoperatively IOP was higher in the Silens PH group than in the CeeOn group (20. 85+/-5.42 vs. 18.88+/-2.95 mm Hg, p= 0.026). The difference was confirmed after 24 h (21.02+/-5.18 vs. 17.34+/-3.18 mm Hg, p < 0.01). Despite the medical treatment (acetazolamide 250 mg orally every 6 h), at the 24-hour control 2 eyes with plate haptic silicone lens showed IOP values higher than 30 mm Hg. Slitlamp examination showed in both eyes a shallowing of the anterior chamber together with the evidence of capsular bag hyperdistension and capsular block resulting from the occlusion of the circular anterior capsule opening by the plate haptic IOL. Residual Healon GV removal from the anterior chamber was performed. At 1-week control both eyes showed normalization of IOP. The use of a plate haptic silicone lens may be associated with a more consistent retention of Healon GV in the eye with trapping in the capsular bag. Retained viscoelastic may cause either trabecular meshwork blockage by viscoelastic substance or postoperative capsular bag hyperdistension, anteroplacement of the IOL optic and capsular block from occlusion of the circular anterior opening by the IOL optic.

Aged↗

[Experiences with transtrabecular iridectomy].

A transtrabecular iridectomy was performed in 17 eyes with narrow angle glaucoma, and in 3 eyes in which the trabecular meshwork was gonioscopically not visible. Postoperatively, the conjunctive lied directly on the sclera in 14 cases; in 6 cases a circumscribed conjunctival bleb developed in the operation field. After a follow-up of 12 or 24 months, the intraocular pressure was normalized without miotics in 15 of 17 eyes. The mechanism of transtrabecular iridectomy is discussed.

Follow-Up Studies↗

Ocular histopathology and ultrastructure of Morquio syndrome (systemic mucopolysaccharidosis IV A).

Morquio syndrome (mucopolysaccharidosis IV) is a hereditary lysosomal storage disease characterized by dwarfism, spondyloepiphyseal and dental abnormalities, corneal opacification, and normal intelligence. We report the light and electron microscopic features of two patients with mucopolysaccharidosis type IV A (MPS IV A). Variable degrees of mucopolysaccharide deposition were seen in tissue surveyed by light microscopy. Transmission electron microscopy demonstrated fibrillogranular and multimembranous membrane-bound inclusions distributed primarily in the cornea and trabecular meshwork, to a milder degree in the conjunctiva and sclera, and rarely in the retinal pigment epithelium. Our findings indicate that the accumulation of mucopolysaccharide in MPS IV A occurs primarily in the structures of the anterior segment.

Adolescent↗

Atypical pigment dispersion syndrome in a child.

PURPOSE: To describe the features of atypical pigment dispersion in a child. DESIGN: Observational case report. METHODS: Retrospective chart review. RESULTS: An 8-year-old boy presented with midperipheral iris transillumination defects, iris backbowing, heavy pigmentation of the trabecular meshwork, and elevated intraocular pressure. He also had several atypical features including emmetropia, mild posterior subcapsular cataract, small pupils, and peripheral anterior synechiae. CONCLUSION: Pigment dispersion in childhood is unusual and may have different features from those classically described in adults.

Cataract↗

A new multipurpose goniolens.

A new goniolens, called the "trabeculens," provides x 1.6 magnification and enhanced resolution of the trabecular meshwork by means of a new optical system that consists of a 30-diopter convex contact lens, hollow funnel, and four mirrors set at 62 degrees angles to one another. The trabeculens can also be used for laser trabeculoplasty, with the addition of an indentor, and for laser iridectomy, with the addition of a 20-diopter planoconvex button lens.

Anterior Chamber↗