Wang Bo, Naithani Rizul, Alvarez Samuel, Glaser Tanya, Freedman Sharon F
From the Wilmer Eye Institute, Johns Hopkins Hospital (B.W.), Baltimore, Maryland; Department of Ophthalmology, Duke University Medical Center (B.W., R.N., S.A., T.G., S.F.F.), Durham, North Carolina, USA..
Department of Ophthalmology, Duke University Medical Center (B.W., R.N., S.A., T.G., S.F.F.), Durham, North Carolina, USA.
Am J Ophthalmol. 2025 Jan;269:402-408. doi: 10.1016/j.ajo.2024.09.001. Epub 2024 Sep 17.
To describe the in vivo morphologic characteristics of the trabecular meshwork (TM), Schlemm canal (SC), and iridocorneal angle in pediatric patients with normal eyes, glaucoma, and cataract.
Prospective cohort study.
A total of 41 children (70 eyes) were enrolled, comprising 28 normal eyes, 19 eyes with glaucoma, and 26 eyes with cataract (15 pre-, 11 post-lensectomy). Average age was 2.8 ± 3.0 years at imaging.
Pediatric patients undergoing clinically indicated examination under anesthesia underwent overhead-mounted optical coherence tomography (OCT) imaging of the outflow pathway. Images were then evaluated for abnormalities in the outflow pathway.
Presence of thickened TM, SC patency, any iridocorneal angle malformation, and episcleral vessel patency in normal eyes vs all other eyes.
Thickened TM tissue was found in no normal eyes, 47.4% of eyes with glaucoma, and 53.8% of eyes with cataracts. A patent SC was demonstrated in all normal eyes, 32% with glaucoma, and 65.4% with cataracts. Iridocorneal angle abnormality was identified in no normal eyes, 94.7% with glaucoma, and 69.2% with cataracts. Prevalence of iridocorneal angle abnormality was similar in cataract eyes pre- and post-lensectomy. All but one eye with glaucoma secondary to anterior segment dysgenesis had patent episcleral vessels. Intraocular pressure (IOP) at imaging was lower in eyes with than without a patent SC (13.9±3.8 mm Hg vs 28.2±11.7 mm Hg, P < .001). IOP was lower in eyes with normal iridocorneal angles compared to those with angle malformation (13.9±3.2 mm Hg vs 22.6±12.1 mm Hg, P < .001). There was no significant difference in IOP between eyes with normal TM thickness compared to those with thickened TM (17.4±8.2 mm Hg vs 17.4±9.5 mm Hg, p = 0.943).
Eyes of children with glaucoma demonstrated thickened TM, decreased patency of SC, and abnormalities of the iridocorneal angle on OCT imaging, compared with normal controls. These abnormal findings also appear in many pediatric eyes with cataracts, even before lensectomy. Future study is warranted to evaluate the role these structural differences may play in the development of glaucoma following cataract surgery and the significant variation in how individual glaucoma eyes respond to angle surgery.
描述正常眼、青光眼和白内障患儿小梁网（TM）、施莱姆管（SC）和虹膜角膜角的体内形态学特征。
前瞻性队列研究。
共纳入41名儿童（70只眼），包括28只正常眼、19只青光眼眼和26只白内障眼（15只白内障术前眼、11只白内障术后眼）。成像时的平均年龄为2.8±3.0岁。
在麻醉下接受临床指征检查的儿科患者接受流出道的头顶安装光学相干断层扫描（OCT）成像。然后评估图像中流出道的异常情况。
正常眼与所有其他眼中增厚的TM、SC通畅情况、任何虹膜角膜角畸形以及巩膜上血管通畅情况。
在正常眼中未发现增厚的TM组织，青光眼眼中有47.4%发现增厚的TM组织，白内障眼中有53.8%发现增厚的TM组织。所有正常眼中SC通畅，青光眼眼中32%通畅，白内障眼中65.4%通畅。正常眼中未发现虹膜角膜角异常，青光眼眼中94.7%发现异常，白内障眼中69.2%发现异常。白内障术前和术后眼中虹膜角膜角异常的发生率相似。除一只继发于前段发育异常的青光眼眼外，所有青光眼眼的巩膜上血管均通畅。成像时，SC通畅的眼内压（IOP）低于SC不通畅的眼（13.9±3.8 mmHg对28.2±11.7 mmHg，P <.001）。虹膜角膜角正常的眼内压低于角畸形的眼（13.9±3.2 mmHg对22.6±12.1 mmHg，P <.001）。TM厚度正常的眼与TM增厚的眼之间的IOP无显著差异（17.4±8.2 mmHg对17.4±9.5 mmHg，p = 0.943）。
与正常对照组相比，青光眼患儿的眼睛在OCT成像上显示出TM增厚、SC通畅性降低和虹膜角膜角异常。这些异常发现也出现在许多患有白内障的儿科眼中，甚至在晶状体切除术前。有必要进行进一步研究，以评估这些结构差异在白内障手术后青光眼发展中可能起的作用，以及个体青光眼眼对角手术反应的显著差异。
