Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute for Medical Sciences, New Delhi, India.
Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, San Diego, CA, USA.
Transl Vis Sci Technol. 2024 Mar 1;13(3):23. doi: 10.1167/tvst.13.3.23.
To compare aqueous humor outflow (AHO) pathway patterns between eyes of childhood glaucoma patients and non-glaucomatous patients receiving cataract surgery.
Aqueous angiography was performed in childhood glaucoma eyes (n = 5) receiving glaucoma surgery and in pediatric (n = 1) and healthy adult (n = 5) eyes receiving cataract surgery. Indocyanine green (0.4%) was introduced into the anterior chamber, and AHO was imaged using an angiographic camera (SPECTRALIS HRA+OCT with Flex Module). Images were acquired and analyzed (ImageJ with Analyze Skeleton 2D/3D plugin) from the nasal sides of the eyes, the usual site of glaucoma angle procedures. Image analysis endpoints included AHO vessel length, maximum vessel length, number of branches, number of branch junctions, and vessel density.
Qualitatively, childhood glaucoma eyes demonstrated lesser AHO pathway arborization compared to pediatric and adult eyes without glaucoma. Quantitatively, childhood glaucoma and healthy adult cataract eyes showed similar AHO pathway average branch lengths and maximum branch lengths (P = 0.49-0.99). However, childhood glaucoma eyes demonstrated fewer branches (childhood glaucoma, 198.2 ± 35.3; adult cataract, 506 ± 59.5; P = 0.002), fewer branch junctions (childhood glaucoma, 74.6 ± 13.9; adult cataract, 202 ± 41.2; P = 0.019), and lower vessel densities (childhood glaucoma, 8% ± 1.4%; adult cataract, 17% ± 2.5%; P = 0.01).
Childhood glaucoma patients demonstrated fewer distal AHO pathways and lesser AHO pathway arborization. These anatomical alternations may result in a new source of trabecular meshwork-independent AHO resistance in this disease cohort.
Elevated distal outflow pathway resistance due to decreased AHO pathway arborization may explain some cases of failed trabecular bypass surgery in childhood glaucoma.
比较儿童青光眼患者和接受白内障手术的非青光眼患者的房水流出（AHO）途径模式。
对接受青光眼手术的儿童青光眼眼（n = 5）和接受白内障手术的儿科（n = 1）和健康成人（n = 5）眼进行房水血管造影。将吲哚菁绿（0.4%）引入前房，并使用血管造影相机（带 Flex 模块的 SPECTRALIS HRA+OCT）对 AHO 进行成像。从眼睛的鼻侧（通常是青光眼角度手术的部位）获取和分析图像（ImageJ 与 Analyze Skeleton 2D/3D 插件）。图像分析终点包括 AHO 血管长度、最大血管长度、分支数量、分支节点数量和血管密度。
定性地，与无青光眼的儿科和成人眼相比，儿童青光眼眼的 AHO 途径分支较少。定量地，儿童青光眼和健康成人白内障眼的 AHO 途径平均分支长度和最大分支长度相似（P = 0.49-0.99）。然而，儿童青光眼眼的分支较少（儿童青光眼，198.2 ± 35.3；成人白内障，506 ± 59.5；P = 0.002），分支节点较少（儿童青光眼，74.6 ± 13.9；成人白内障，202 ± 41.2；P = 0.019），血管密度较低（儿童青光眼，8% ± 1.4%；成人白内障，17% ± 2.5%；P = 0.01）。
儿童青光眼患者表现出较少的远端 AHO 途径和较少的 AHO 途径分支。这些解剖学变化可能导致该疾病队列中小梁网独立 AHO 阻力的新来源。
医学博士简·李
