Department of Ophthalmology, Japanese Red Cross Medical Center, Shibuya-Ku, Tokyo, Japan; Department of Ophthalmology, Ishida Eye Clinic, Joetsu, Japan.
School of General and Management Studies, Suwa University of Science, Suwa, Japan.
Exp Eye Res. 2021 Sep;210:108711. doi: 10.1016/j.exer.2021.108711. Epub 2021 Aug 2.
The histologic differences in Schlemm's canal (SC) and trabecular meshwork (TM), obtained from the trabeculectomy specimens of different age-group glaucoma patients, were compared. This study involved 44 trabeculectomy specimens of 37 juvenile-onset open-angle glaucoma (JOAG) patients (Group A) and 24 trabeculectomy specimens of 24 elderly-onset primary OAG (POAG) patients (age range: 70-79 years, Group B) with no familial history of POAG. Clinical parameters of gender, maximum intraocular pressure (IOP), and the number of glaucoma medications used prior to trabeculectomy were investigated and compared between the two groups. From light microscopy photographs of hematoxylin-eosin, and immunohistochemical staining of markers for SC endothelium (SCE), the total SC length (TSC), comprised of the opened-SC length (OSC) and the closed-SC length (CSC), the percentage of CSC in TSC (%CSC), the percentage of positive SCE marker in CSC (%PinCSC), and the percentage of negative SCE marker in OSC (%NinOSC) were analyzed. Moreover, podoplanin staining patterns in the TM were investigated and compared between the two groups. Among the clinical parameters, the mean maximum IOP in Group A (33.41 ± 9.24 mmHg) was the only significant parameter when compared to that in Group B (22.96 ± 7.17 mmHg, P = 0.000003). TSC in Group A was significantly shorter than that in Group B (P = 0.00092), and %CSC (P = 0.00004) and %PinCSC (P = 0.00342) in Group B were significantly higher than those in Group A. No statistically significant difference in %NinOSC was found between Group A and Group B (P = 0.76060). Juxtacanalicular tissue (JCT) in Group A showed compact and weak staining with podoplanin, while the JCT and closed-SC area in Group B showed intense staining. In the Group A subjects, TSC (P = 0.04819) and OSC (P = 0.02867) were significantly shorter in the non-familial cases than in the familial cases. Platelet coagulations 10-37 μm in size at the defect of the SCE in the inner wall of the SC were observed in 8 eyes (18%) and 4 eyes (17%) in Group A and Group B, respectively. The platelets appeared to repair the SCE damage for maintaining the blood aqueous barrier in both groups of POAG eyes. Smaller SC diameters and accompanying TM abnormality were features observed in the young-onset JOAG patients, thus suggesting developmental abnormalities in the outflow routes. The collapse of SC lumen, presumably due to aging, was the feature observed in the elderly-onset POAG patients. In Group A, the significantly higher IOP, despite of no significant number of topical medications used prior to trabeculectomy, also suggested that JOAG eyes can be categorized as a distinct type of POAG from the eyes of elder-aged POAG patients. The SCE drop out observed in the glaucomatous eyes of the different age groups suggested that worsening of IOP control may possibly occur equally in both groups.
比较了来自不同年龄组青光眼患者的小梁切除术标本中的施莱姆氏管(SC)和小梁网(TM)的组织学差异。本研究涉及 37 例青少年起病开角型青光眼(JOAG)患者(A 组)的 44 例小梁切除术标本和 24 例老年起病原发性开角型青光眼(POAG)患者(年龄范围:70-79 岁,B 组)的 24 例小梁切除术标本。无 POAG 的家族史。比较了两组患者的性别、最大眼内压(IOP)和小梁切除术前使用的青光眼药物数量等临床参数。从苏木精-伊红的光镜照片和 SC 内皮标志物(SCE)的免疫组织化学染色,分析了总 SC 长度(TSC),包括开放 SC 长度(OSC)和闭合 SC 长度(CSC),TSC 中的 CSC 百分比(%CSC),CSC 中阳性 SCE 标志物的百分比(%PinCSC)和 OSC 中阴性 SCE 标志物的百分比(%NinOSC)。此外,还比较了两组 TM 中的 podoplanin 染色模式。在临床参数中,A 组的平均最大 IOP(33.41±9.24mmHg)是唯一与 B 组(22.96±7.17mmHg,P=0.000003)相比有显著差异的参数。A 组的 TSC 明显短于 B 组(P=0.00092),B 组的%CSC(P=0.00004)和%PinCSC(P=0.00342)明显高于 A 组。A 组和 B 组之间的%NinOSC 无统计学差异(P=0.76060)。A 组的管周组织(JCT)显示致密且染色较弱,而 B 组的 JCT 和闭合 SC 区域显示强烈染色。在 A 组患者中,非家族性病例的 TSC(P=0.04819)和 OSC(P=0.02867)明显短于家族性病例。在 A 组和 B 组中,分别有 8 只眼(18%)和 4 只眼(17%)的 SC 内壁 SCE 缺陷处有 10-37μm 大小的血小板凝块。这些血小板似乎修复了 SCE 损伤,以维持两组 POAG 眼的血房水屏障。在年轻起病的 JOAG 患者中观察到较小的 SC 直径和伴随的 TM 异常,这表明流出途径存在发育异常。SC 管腔的塌陷,大概是由于衰老,是在老年起病的 POAG 患者中观察到的特征。在 A 组中,尽管小梁切除术前使用的局部药物数量没有明显增加,但 IOP 仍显著升高,这也表明 JOAG 眼可以从老年 POAG 患者的眼中归类为一种独特类型的 POAG。不同年龄组青光眼眼中观察到的 SCE 缺失表明,两组的眼压控制可能同样恶化。