Morphological variability of the trabecular meshwork in glaucoma patients: implications for non-perforating glaucoma surgery
Thomas S Dietlein, Philipp C Jacobi, Christoph Lüke, Günter K Krieglstein
Department
of Ophthalmology, University of Cologne, Germany
Correspondence to: Dr Dietlein, Department of Ophthalmology, University of Cologne, Joseph-Stelzmann-Strasse 9, D-50931 Köln, Germany aia47{at}uni-koeln.de
Accepted for publication 28 June 2000
BACKGROUND/AIMS
Morphological
variability of the trabecular meshwork could be of considerable
importance for the proper intraoperative outcome of non-perforating
antiglaucomatous surgery, such as deep sclerectomy and
viscocanalostomy. The aim of this study was therefore to assess qualitative and quantitative characteristics of the trabecular meshwork
in glaucoma patients undergoing trabeculectomy.
METHODSTrabeculectomy
specimens from 177 glaucoma patients were prepared for light
microscopy; 100 specimens were found to be suitable for qualitative
assessment and quantitative computerised image analysis; measurements
were taken of the meridional diameter of Schlemm's canal as well as
the thickness of the trabecular meshwork at different positions.
RESULTSThe mean
meridional diameter of Schlemm's canal was 290 µm with the smallest
values in the young patients with infantile and secondary glaucomas.
the thickness of the trabecular meshwork ranged between 50-70 µm in
the anterior region and between 100-130 µm for the posterior
portion. The thickness of the anterior meshwork significantly decreased
with age. The pigmentation of excised trabecular meshwork was found to
be weak or even lacking in 68 patients. In 20 glaucoma patients the
uveal meshwork was covered by an endothelial layer.
CONCLUSIONSFrom the
morphological point of view the risk of inadvertent perforation during
deep sclerectomy in older, white glaucoma patients should be taken into
account even by an experienced surgeon, because the anterior meshwork
in these cases is very thin and trabecular pigmentation that can be
used as a topographic landmark is often lacking. The functional success
of non-perforating glaucoma surgery in many patients may be limited by
endothelial covering of the trabecular meshwork.
© 2000 by British Journal of Ophthalmology
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Br. J. Ophthalmol. 2000 84: 1339-1341.[Extract] [Full Text] [PDF]
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