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1 General aspects (0)   1.1 Epidemiology (5)   1.2 Population genetics (15)   1.3 Pathogenesis (6)   1.4 Quality of life (5)   1.5 Glaucomas as cause of blindness (0)   1.6 Prevention and screening (5) 2 Anatomical structures in glaucoma (0)   2.1 Conjunctiva (2)   2.2 Cornea (3)   2.3 Sclera (0)   2.4 Anterior chamber angle (0)   2.5 Meshwork (16)     2.5.1 Trabecular meshwork (0)     2.5.2 Schlemms canal (0)     2.5.3 Scleral outlet channels (0)   2.6 Aqueous humor dynamics (5)     2.6.1 Production (0)     2.6.2 Outflow (0)       2.6.2.1 Trabecular meshwork (0)       2.6.2.2 Uveoscleral (0)     2.6.3 Compostion (0)   2.7 Episcleral veins and venous pressure (0)   2.8 Iris (0)   2.9 Ciliary body (0)   2.10 Lens (0)   2.11 Vitreous body (1)   2.12 Choroid, peripapillary choroid, peripapillary atrophy (1)   2.13 Retina and retinal nerve fibre layer (14)   2.14 Optic disc (16)   2.15 Optic nerve (0)   2.16 Chiasma and retrochiasmal central nervous system (0)   2.17 Stem cells (0)   2.20 Other (0) 3 Laboratory methods (9)   3.1 Microscopy (0)   3.2 Electron microscopy (3)   3.3 Immunohistochemistry (1)   3.4 Molecular genetics (1)     3.4.1 Linkage studies (0)     3.4.2 Gene studies (0)   3.5 Molecular biology incl. SiRNA (0)   3.6 Cellular biology (0)   3.7 Biochemistry (0)   3.8 Pharmacology (0)   3.9 Pathophysiology (0)   3.10 Immunobiology (0)   3.11 Pharmacogenetics (0)   3.12 Proteomics (0)   3.13 In vivo imaging (0)     3.13.1 Laser Scanning (0)       3.13.1.1 Confocal Scanning Laser Ophthalmoscopy (0)       3.13.1.2 Confocal Scanning Laser Polarimetry (0)     3.13.2 Optical Coherence Tomography (0)       3.13.2.1 Anterior Segment (0)       3.13.2.2 Posterior Segment (0)     3.13.3 RGC Imaging (0)     3.13.4 Other (0)   3.20 Other (0) 4 Tissue culture of ocular cells (3) 5 Experimental glaucoma; animal models (16)   5.1 Rodent (0)   5.2 Primates (0)   5.3 Other (0) 6 Clinical examination methods (1)   6.1 Intraocular pressure measurement; factors affecting IOP (15)     6.1.1 Devices, techniques (0)     6.1.2 Fluctuation, circadian rhythms (0)     6.1.3 Factors affecting IOP (0)   6.2 Tonography, aqueous flow measurement (see also 2.6) (0)   6.3 Biomicroscopy (slitlamp) (0)     6.3.1 Anterior segment (0)     6.3.2 Posterior segment (0)   6.4 Gonioscopy (0)   6.5 Ophthalmoscopy (0)   6.6 Visual field examination and other visual function tests (1)     6.6.1 Conventional manual (1)     6.6.2 Automated (2)     6.6.3 Special methods (e.g. color, contrast, SWAP etc.) (20)   6.7 Electro-ophthalmodiagnosis (6)   6.8 Photography (0)     6.8.1 Anterior segment (1)     6.8.2 Posterior segment (3)   6.9 Computerized image analysis (1)     6.9.1 Laser scanning (9)       6.9.1.1 Confocal Scanning Laser Ophthalmoscopy (0)       6.9.1.2 Confocal Scanning Laser Polarimetry (0)     6.9.2 Optical coherence tomography (5)       6.9.2.1 Anterior (0)       6.9.2.2 Posterior (0)     6.9.5 Other (1)   6.10 Fluorescein (ICG) angiography (0)     6.10.1 Anterior segment (0)     6.10.2 Posterior segment (0)   6.11 Bloodflow measurements (15)   6.12 Ultrasonography and ultrasound biomicroscopy (6)   6.13 Provocative tests (1)   6.19 Telemedicine (0)   6.20 Progression (1)   6.30 Other (0) 8 Refractive errors in relation to glaucoma (1)   8.1 Myopia (3)   8.2 Hypermetropia (0)   8.3 Contact lenses (0)   8.4 Refractive surgical procedures (2)   8.5 Other (0) 9 Clinical forms of glaucomas (0)   9.1 Developmental glaucomas (0)     9.1.1 Congenital glaucoma, Buphthalmos (1)     9.1.2 Juvenile glaucoma (1)     9.1.3 Syndromes of Axenfeld, Rieger, Peters, aniridia (3)     9.1.4 Other (0)   9.2 Primary open angle glaucomas (0)     9.2.1 Ocular hypertension (1)     9.2.2 Other risk factors for glaucoma (5)     9.2.3 Open angle glaucoma with elevated IOP (2)     9.2.4 Normal pressure glaucoma (5)   9.3 Primary angle closure glaucomas (0)     9.3.1 Acute primary angle closure glaucoma (pupillary block) (7)     9.3.2 Chronic primary angle closure glaucoma (pupillary block) (2)     9.3.3 Plateau iris syndrome (0)     9.3.4 Primary angle closure suspect (0)     9.3.5 Primary angle closure (0)     9.3.10 Other (1)   9.4 Glaucomas associated with other ocular and systemic disorders (0)     9.4.1 Steroid-induced glaucoma (2)     9.4.2 Glaucomas associated with disorders of the cornea, conjunctiva, sclera (0)       9.4.2.1 Iridocorneal endothelial syndrome (ICE, incl. irisatrophy) (0)       9.4.2.2 Posterior polymorphous dystrophy (0)       9.4.2.3 Fuchs' endothelial dystrophy (0)       9.4.2.5 Other (0)     9.4.3 Glaucomas associated with disorders of the iris and ciliary body (0)       9.4.3.1 Pigmentary glaucoma (0)       9.4.3.5 Other (0)     9.4.4 Glaucomas associated with disorders of the lens (1)       9.4.4.1 Exfoliation syndrome (7)       9.4.4.2 Glaucomas associated with cataracts (0)       9.4.4.3 Glaucomas associated with lens dislocation (0)       9.4.4.5 Other (0)     9.4.5 Glaucomas associated with disorders of the retina, choroid and vitreous (0)       9.4.5.1 Neovascular glaucoma (3)       9.4.5.5 Other (0)     9.4.6 Glaucomas associated with inflammation, uveitis (5)     9.4.7 Glaucomas associated with ocular trauma (0)     9.4.8 Glaucomas associated with intraocular tumors (0)     9.4.9 Glaucomas associated with elevated episcleral venous pressure (0)       9.4.10 Glaucomas associated with hemorrhage (0)     9.4.11 Glaucomas following intraocular surgery (0)       9.4.11.1 Ciliary block (malignant) glaucoma (0)       9.4.11.2 Glaucomas in aphakia and pseudophakia (0)       9.4.11.3 Epithelial, fibrous, and endothelial proliferation (0)       9.4.11.4 Glaucomas associated with corneal surgery (2)       9.4.11.5 Glaucomas associated with vitreoretinal surgery (3)     9.4.15 Glaucoma in relation to systemic disease (6)     9.4.20 Other (0) 10 Differential diagnosis e.g. anterior and posterior ischemic optic neuropathy (7) 11 Medical treatment (0)   11.1 General management, indication (9)   11.2 Cholinergic drugs (0)   11.3 Adrenergic drugs (0)     11.3.1 Epinephrine (0)     11.3.2 Thymoxamine, dapiprazole (0)     11.3.3 Apraclonidine, brimonidine (6)     11.3.4 Betablocker (16)     11.3.5 Other (0)   11.4 Prostaglandins (24)   11.5 Carbonic anhydrase inhibitors (0)     11.5.1 Systemic (0)     11.5.2 Topical (8)   11.6 Osmotic treatment (0)   11.7 Treatment of bloodflow (1)   11.8 Neuroprotection (4)   11.9 Gene therapy (1)   11.13 Combination therapy (0)     11.13.1 Betablocker and pilocarpine (0)     11.13.2 Betablocker and carbon anhydrase inhibitor (0)     11.13.3 Betablocker and brimonidine (0)     11.13.4 Betablocker and prostaglandin (0)     11.13.5 Other (0)   11.14 Investigational drugs; pharmacological experiments (7)   11.15 Other drugs in relation to glaucoma (2)   11.16 Vehicles, delivery systems, pharmacokinetics, formulation (0)   11.17 Cooperation with medical therapy e.g. persistency, compliance, adherence (0)   11.20 Other (0) 12 Surgical treatment (0)   12.1 General management, indication (2)   12.2 Laser iridotomy (1)   12.3 Laser iridoplasty (2)   12.4 Laser trabeculoplasty and other laser treatment of the angle (2)   12.7 Surgical iridectomy (0)   12.8 Filtering surgery (2)     12.8.1 Without tube implant (6)     12.8.2 With tube implant or other drainage devices (9)     12.8.3 Non-perforating (6)     12.8.4 Using laser (1)     12.8.5 Other (0)     12.8.10 Woundhealing antifibrosis (7)     12.8.11 Complications, endophthalmitis (8)   12.9 Trabeculotomy, goniotomy (3)   12.10 Cyclodestruction (4)   12.11 Cyclodialysis (0)   12.12 Cataract extraction (0)     12.12.1 Intracapsular (0)     12.12.2 Extracapsular (1)     12.12.3 Phacoemulsification (9)   12.14 Combined cataract extraction and glaucoma surgery (0)     12.14.1 Intracapsular (0)     12.14.2 Extracapsular (1)     12.14.3 Phacoemulsification (9)   12.15 Capsulotomy (0)   12.16 Vitrectomy (0)   12.17 Anesthesia (6)   12.20 Other (4) 13 Therapeutic prognosis and outcome (0)   13.1 Prognostic factors (0)   13.2 Outcome (0)     13.2.1 IOP (0)     13.2.2 Visual field (0)       13.2.2.1 Progression (0)       13.2.2.2 Improvement (0)     13.2.3 Other (0) 14 Costing studies; pharmacoeconomics (4) 15 Miscellaneous (4)

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Abstract #8044 Published in IGR 4-3

Confocal microscopic examination of trabecular meshwork removed during ab externo trabeculectomy

Hamard P; Valtot F; Sourdille P; Bourles-Dagonet F; Baudouin C
British Journal of Ophthalmology 2002; 86: 1046-1052

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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 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 analyzed with a confocal microscope. RESULTS: Glaucomatous ETM (mean thickness: 29.5 (7.6) μm) were characterized 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.

P. Hamard, MD, Department of Ophthalmology, Quinze-Vingts Hospital Paris, University Paris V, France. pascale-hamard@quinze-vingts.fr

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Classification:

12.8.3 Non-perforating (Part of: 12 Surgical treatment > 12.8 Filtering surgery)

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