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Trabecular Meshwork Response to Pressure Elevation in the Living Human Eye
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Quantification of Focal Outflow Enhancement Using Differential Canalograms.

Ralitsa T Loewen1, Eric N Brown2, Gordon Scott1

  • 1Department of Ophthalmology University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.

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|May 27, 2016
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Summary
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Ab interno trabeculectomy (AIT) significantly enhances aqueous humor outflow in pig eyes, increasing it up to 17-fold in specific regions. This study developed a novel technique to quantify these substantial outflow improvements after AIT.

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Area of Science:

  • Ophthalmology
  • Glaucoma Research
  • Surgical Innovation

Background:

  • Glaucoma is a leading cause of blindness characterized by elevated intraocular pressure.
  • Ab interno trabeculectomy (AIT) is a surgical technique aimed at improving aqueous humor outflow.
  • Accurate quantification of outflow changes post-AIT is crucial for evaluating its efficacy.

Purpose of the Study:

  • To quantify regional changes in conventional aqueous humor outflow following ab interno trabeculectomy (AIT).
  • To establish and validate a novel method for measuring outflow alterations after AIT.

Main Methods:

  • Plasma-mediated AIT was performed on enucleated pig eyes.
  • A custom R package (eye-canalogram) was developed for automated outflow quantification using fluorescent tracer reperfusion.
  • Two-dye reperfusion canalograms and histology were used to assess trabecular meshwork (TM) ablation and Schlemm's canal patency.

Main Results:

  • Histology confirmed TM ablation and unroofing of Schlemm's canal segments.
  • Differential canalograms revealed significant outflow increases: 17±5-fold inferonasally and 14±3-fold superonasally.
  • Outflow also increased in other quadrants (2±1-fold superotemporally, 3±3-fold inferotemporally), with accelerated nasal filling and perilimbal flow.

Conclusions:

  • A quantitative, differential canalography technique was successfully developed.
  • This method enables precise measurement of supraphysiological outflow enhancement achieved by AIT.
  • The findings demonstrate AIT's potential to substantially increase aqueous humor outflow in a clinically relevant model.