Indian Journal of Ophthalmology

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

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


NN Sood, AR Raghu Ram 
 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
India




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 clinico­pathological study.Indian J Ophthalmol 1983;31:947-950


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Sood N N, Raghu Ram A R. Histopathological and histochemical analysis of trabeculectomy specimens in open angle and steroid induced claucoma-a clinico­pathological study. Indian J Ophthalmol [serial online] 1983 [cited 2024 Mar 28 ];31:947-950
Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?1983/31/7/947/29713


Full Text

Trabeculectomy specimens offer a unique opportunity for the study of morphological alt­erations 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 sequ­ence 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



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 com­plete 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 ten­sion 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 al­lergic conjunctivitis. Intraocular tension ranged between 26-50mm. Hg with mean ap­planation tension 40.5 mm. Hg. Disc examina­tion 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 in­tracoular 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 usu­ally formed near the termination of De­scemet's membrane. In antero-posterior sec­tion the meshwork region show up as minute rods arranged in layers with intertrabesular spaces [Figure 1].

In open angle glaucoma the following his­topathological changes were seen. Normal meshwork-5 eyes, compression-2 eyes; pig­ment dispersion 1 eyes; Trabecular sopara­tion, 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 find­ing 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-blue­PAS 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



Histological changes in the trabecular meshwork in cases of Open angle glaucoma have been described under light and electron­microscopy[2]. Electron microscopy of two cases of steroid induced glaucoma have been de­scribed by Rohan et al 1973[4]. However, no at­tempt has been made as far as we are aware of utilising the trabeculectomy specimens for his­tochemical studies. The AMPS was studied by using the modified Armaly and Wang Method.[3] Earlier studies of trabeculectomy specimens have shown widening and densifi­cation 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 de­monstration of AMPS in trabeculgctomy specimen would favour the diagnosis of steroid glaucoma. A direct co-relation bet­ween histopathological, histochemical and clinical parameters was not found.

 SUMMARY AND CONCLUSION



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 col­loidal 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. Histochem­ically demonstrable Acid MPS was found in all cases of steroid glaucoma but none in open angle glaucoma. In case of difficulty in dif­ferentiating between open angle and steroid glaucoma histochemically demonstrable AMPS in the meshwork would favour the diagnosis of steroid glaucoma.

References

1Sampaolesi, R. 1974, Documenta Ophthalmolgica Proceedings Series, Genesis of glaucoma Wessely sym. Munich, p.67.
2Rodrigues et al 1976 Trans. Ophthalmol. Sec. U.K., 245-255.
3Armaly, M.F. and Wang, Y., 1975, In­ vest. Ophthalmol. :14:507-516.
4Rohan, J.W. et ai, 1973, Exp. Eye Res. 17:19-31.
5Francois, J. 1975 Invest. Ophthalmol.14:173.