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Year : 1983  |  Volume : 31  |  Issue : 7  |  Page : 947-950

Histopathological and histochemical analysis of trabeculectomy specimens in open angle and steroid induced claucoma-a clinico計athological study

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

Correspondence Address:
N N Sood
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIMS, New Delhi-110 029
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Source of Support: None, Conflict of Interest: None

PMID: 6544294

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How to cite this article:
Sood N N, Raghu Ram A R. Histopathological and histochemical analysis of trabeculectomy specimens in open angle and steroid induced claucoma-a clinico計athological study. Indian J Ophthalmol 1983;31, Suppl S1:947-50

How to cite this URL:
Sood N N, Raghu Ram A R. Histopathological and histochemical analysis of trabeculectomy specimens in open angle and steroid induced claucoma-a clinico計athological study. Indian J Ophthalmol [serial online] 1983 [cited 2021 Oct 18];31, Suppl S1:947-50. Available from: https://www.ijo.in/text.asp?1983/31/7/947/29713

Trabeculectomy specimens offer a unique opportunity for the study of morphological alt苟rations involving trabecular meshwork and outflow channels in glaucoma.[1],[2] Such surgical biopsy specimens are more representative of histopathological changes in glaucoma than are autopsy eyes in which autolysis and end stage disease may complicate the true sequ苟nce of events. Very little is known about the morphological changes produced by topically administered corticosteroid.

In this study trabeculectomy specimens from cases of open angle and steroid induced glaucoma have been utilised for histological & tiistochemical studies. As far as we are aware of no histochemical study on trabeculectomy specimens is available.

  Materials and methods Top

Trabeculectomy specimens obtained from ten cases of open angle glaucoma and four cases of steroid induced glaucoma were studied under light microscopy after staining with H & E, colloidal iron and Alcian blue PAS.

Trabeculectomy specimens obtained from five', eye bank eyes served as control specimens. Every case of glaucoma was subjected to com計lete clinical examination and all specimens were cut in to 5 U thick sections for staining. All specimens were stained with H & E : Alcian blue - PAS and colloidal irons. Observations and Results:

Of the ten cases of open angle glaucoma females with age group between 30-60 years (Mean age: 48.9 years). Applanation tension ranged between 26-56 mm. Hg with mean ten貞ion of 32 mm. Hg. C : D ratio ranged between 0.4:1 to 0.9:1 in the worse eye. Field examina-n tion showed typical field defects in four cases.

C-value ranged between 0.04 - 0.20 U 1/minute (Mean C value 0.084 U1/ min.).

Of the four cases of steroid induced glaucoma two were males and ' two were females with age groups ranging between 1220 yrs. (Mean age 16.75 yrs). All the patients had used pyrimon eye drops (Dexamethasone 0.1% and chloramphemical 1%) three to four times daily in both eyes for 2-8 months for al衍ergic conjunctivitis. Intraocular tension ranged between 26-50mm. Hg with mean ap計lanation tension 40.5 mm. Hg. Disc examina負ion shows C:D ratio ranging between 0.4:1 to 0.9:1. Tonographic outflow facility ranged be tween 0.01 - 0.07U 1/min. (Mean C-value - 0.040 U1/Min.). In all cases undergoing surgery, there was inadequate control of in負racoular pressure after stopping local steroids and use of epinephrine group of drugs alone or in combination with miotics. Histopathology:

Trabeculectomy specimens consist of two portions, transparent corneal portion and opaque scleral are separating which the trabecular band which is usually pigmented runs across. The trabecular meshwork is usu苔lly formed near the termination of De貞cemet's membrane. In antero-posterior sec負ion the meshwork region show up as minute rods arranged in layers with intertrabesular spaces [Figure - 1].

In open angle glaucoma the following his負opathological changes were seen. Normal meshwork-5 eyes, compression-2 eyes; pig衫ent dispersion 1 eyes; Trabecular sopara負ion, antolysis and thickening 1 eye, Autojysis 1 eye.

Canal of Schlemn was seen in two cases, in one specimen canal appeared narrowed. In comprersion the morphology and general architecture of meshwork was maintained with narrowing of intertrabecular spaces. In one case there was disruption of normal architecture of trabecular beams with breaks and thickening in the trabecular beams. [Figure - 2]. In autolysis the total architecture of moshwork is lost with tissue appearing as homogenous pink mass. [Figure - 3].

In steroid induced glaucoma following changes were seen: Normal meshwork 2 eyes, Compression-1 eye, Homogenisation I eye. The meshwork appeared more dense and travecular beams appear smudgy with loss of nuclei in homogenisation. [Figure - 4]. This find虹ng has not been described earlier.

Histochemistry : In the control eyes & in open angle glaucoma, none of the specimens showed any ovedence of AMPS in the trabecular reshwork or in the canal of Schlemn.

In steroid glaucoma all cases showed evidence AMPS in the meshwork to both the stains, however, the reaction to Alcian-blue致AS was much stronger compared to colloidal iron. The mueopolysacharide granules appeared as bluish stains and were predbminently along the beams of trabecular meshwork. Some bluish stains was also seen in the intertrabecular spaces. There was no evidence of AMPS in the canal of Schlemn. No More specific morphological pattern of distribution fo AMPS was found. [Figure - 5].

  Discussion Top

Histological changes in the trabecular meshwork in cases of Open angle glaucoma have been described under light and electron衫icroscopy[2]. Electron microscopy of two cases of steroid induced glaucoma have been de貞cribed by Rohan et al 1973[4]. However, no at負empt has been made as far as we are aware of utilising the trabeculectomy specimens for his負ochemical studies. The AMPS was studied by using the modified Armaly and Wang Method.[3] Earlier studies of trabeculectomy specimens have shown widening and densifi苞ation of juxta canalicular tissue in steroid glaucoma.[4] The role of acid MPS with special reference to steroids and the role of goniocytes have been well documented.[5] From this study it is obvious that trabeculectomy specimens can be utilised for histological sudies. In doubtful cases as to the nature of glaucoma de衫onstration of AMPS in trabeculgctomy specimen would favour the diagnosis of steroid glaucoma. A direct co-relation bet趴een histopathological, histochemical and clinical parameters was not found.

  Summary and conclusion Top

Trabecuectomy specimens obtained from ten cases of open angle glaucoma and four cases of steroid glaucoma was studied under light microscopy and histochemical analysis for the presence of AMPS was done using col衍oidal iron & Alcian blue-PAS stains. Changes like compression, degeneration, disruption, trabecular thickening and autolysis were seen in open angle glaucoma and homogenisation of meshwork in steroid glaucoma. Histochem虹cally demonstrable Acid MPS was found in all cases of steroid glaucoma but none in open angle glaucoma. In case of difficulty in dif苯erentiating between open angle and steroid glaucoma histochemically demonstrable AMPS in the meshwork would favour the diagnosis of steroid glaucoma.

  References Top

Sampaolesi, R. 1974, Documenta Ophthalmolgica Proceedings Series, Genesis of glaucoma Wessely sym. Munich, p.67.  Back to cited text no. 1
Rodrigues et al 1976 Trans. Ophthalmol. Sec. U.K., 245-255.  Back to cited text no. 2
Armaly, M.F. and Wang, Y., 1975, In vest. Ophthalmol. :14:507-516.  Back to cited text no. 3
Rohan, J.W. et ai, 1973, Exp. Eye Res. 17:19-31.  Back to cited text no. 4
Francois, J. 1975 Invest. Ophthalmol.14:173.  Back to cited text no. 5


  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]


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