The trabecular meshwork in acute and chronic angle closure glaucoma.
The trabecular meshwork in acute and chronic angle closure glaucoma.
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发表时间：
2001-12
影响因子：
3.1
通讯作者：
R. Sihota;N. Lakshmaiah;KB Walia;Sanjiv Sharma;J. Pailoor;Agarwal Hc
中科院分区：
文献类型：
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作者：
R. Sihota;N. Lakshmaiah;KB Walia;Sanjiv Sharma;J. Pailoor;Agarwal Hc
目的探讨急性和慢性原发性闭角型青光眼（PACG）对小梁网的影响。方法对16例原发性闭角型青光眼（PACG）患者的小梁标本进行光镜和电镜观察，其中急性PACG 6眼，慢性PACG 10眼。结果急性PACG：小梁网显示广泛性水肿和色素在增宽的小梁间隙和Schlemm管中积聚。减弱的小梁内皮细胞似乎缺乏亚细胞成分。慢性PACG：在慢性PACG眼中，小梁结构失去了其规则的排列，小梁间隙变少变窄，区域内小梁梁融合。在小梁组织中，无论是在小梁内还是在细胞外间隙，都有许多电子致密体，具有带状纤维结构。观察到内皮细胞的总体损失;剩余的细胞拥挤在一起并且是多态的。基质和内皮细胞中均可见黑色素。结论：急性闭角型青光眼后小梁网的主要改变是色素在小梁间隙和细胞内的积聚以及非炎性变性。在慢性PACG眼中，有证据表明内皮细胞和反应性修复过程的损失。这些变化存在于远离可见外周前粘连的区域。前房角镜单独评估外周前粘连的程度可能不能反映急性和慢性PACG中小梁网损伤的程度。经历PACG急性发作的患者需要长期随访，因为眼内压（IOP）可能会在以后升高，这是由于持续的变化损害了流出功能，或由于小梁网老化的影响。
PURPOSE To determine the effect of acute and chronic primary angle closure glaucoma (PACG) on the trabecular meshwork. METHODS Trabecular specimens of 16 consecutive patients with primary angle closure glaucoma (PACG)--6 acute PACG eyes, and 10 chronic PACG eyes without an acute attack--were studied by light and electron microscopy. RESULTS Acute PACG: The trabecular meshwork revealed a generalised oedema and an accumulation of pigment in the widened trabecular spaces and Schlemm's canal. Attenuated trabecular endothelial cells appeared to be devoid of subcellular components. Chronic PACG: In chronic PACG eyes the trabecular architecture had lost its regular arrangement, with fewer and narrower trabecular spaces and fusion of the trabecular beams in areas. There were numerous electron-dense bodies in the trabecular tissues, both within the trabecular beams and in the extracellular spaces, which had a banded fibrillar structure. An overall loss of endothelial cells was noted; the remaining cells were crowded together and were polymorphic. Melanin pigment was present both within the stroma and in the endothelial cells. CONCLUSIONS Pigment accumulation in the trabecular spaces and within the cells and a noninflammatory degeneration appeared to be the primary changes in the trabecular meshwork after acute angle closure glaucoma. In chronic PACG eyes, there was evidence of loss of endothelial cells and reactive repair processes. These changes were present in areas away from visible peripheral anterior synechiae. A gonioscopic evaluation of the extent of peripheral anterior synechiae alone may not reflect the extent of trabecular meshwork damage in acute and chronic PACG. Patients experiencing an acute attack of PACG require a long-term follow up, because the intraocular pressure (IOP) may rise later, due to ongoing changes compromising the outflow facility, or due to the effects of aging in the trabecular meshwork.