The outflow pathway in congenital glaucoma.

We obtained specimens from the angle of the eye during a trabeculotomy-trabeculectomy operation of a 5-month-old boy with congenital glaucoma. Light and electron miscroscopy of the anterior chamber angle showed the presence of mesodermal tissue covering the entire trabecular area. The trabecular meshwork showed thickening of trabecular beams, and an increased amount of collagen fibrils in the trabecular matrix. Internal trabecular spaces contained red blood cells; outer trabecular spaces were not apparent. The juxtacanalicular trabecular meshwork was thicker than in normal cases, because of an increased amount of collagen fibrils. The endothelium of Schlemm's canal was underlined by a thick and constant layer of amorphous material. These observations suggested that the site of increased resistance to aqueous humor outflow in congenital glaucoma could be found in abnormalities of the trabecular meshwork and the internal wall of Schlemm's canal.