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Editors Selection IGR 17-4
Anatomical Structures: Outflow pathways in childhood glaucoma
Comment by Kaweh Mansouri on:
116894 Reduced Aqueous Humor Outflow Pathway Arborization in Childhood Glaucoma Eyes, Gupta S; Zhang X; Panigrahi A; Panigrahi A et al., Translational vision science & technology, 2024; 13: 23
The hypothesis of this interesting paper by Gupta et al. is that studying abnormal aqueous humor outflow (AHO) is more straightforward in childhood glaucoma since the relationship between IOP and glaucoma is less complex than in adult forms of the disease. To do so, the authors applied aqueous angiography with indocyanine green (0.4%) to evaluate AHO patterns in five eyes with childhood glaucoma undergoing glaucoma surgery and compared these to one pediatric eye and five healthy adult eyes undergoing cataract surgery.
They found that childhood glaucoma eyes demonstrated reduced AHO pathway arborization compared to pediatric and adult eyes without glaucoma. Although childhood glaucoma and healthy adult cataract eyes showed similar AHO pathway branch lengths, childhood glaucoma eyes demonstrated significantly fewer branches and branch junctions and lower vessel densities.
For the first time, a study has demonstrated that pediatric glaucoma patients have reduced distal AHO pathways. This finding may explain why trabeculotomies (both external or internal) may be ineffective in this age group. As interesting as this finding is in itself, as so often in glaucoma, the sequence of damage remains unknown for now: whether distal AHO pathway changes are due to primary dysgenesis of the vessels or high IOP vessel collapse from lack of flow that subsequently could be rescued later.
The sequence of damage remains unknown for now: whether distal AHO pathway changes are due to primary dysgenesis of the vessels or high IOP vessel collapse from lack of flow that subsequently could be rescued later
This study is, of course, limited by a small sample size, by the fact that childhood glaucoma eyes are compared to adult cataract eyes among others. However, these limitations are to be seen in the context of a technically difficult and invasive examination method that was performed in a vulnerable patient cohort. The authors should therefore be congratulated for this study and the light in sheds into the fundamental aspects of glaucoma.
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