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Published on: June 3, 2018
Correlation of histopathology of trabecular meshwork with clinical features in primary congenital glaucoma
Rinky Agarwal1, Seema Sen2, Seema Kashyap2
1Glaucoma research facility and services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Insights
Histopathological analysis of trabecular meshwork in primary congenital glaucoma (PCG) can predict clinical outcomes. Microscopic findings like eosinophilic membrane and fused beams correlate with intraocular pressure, guiding PCG prognosis.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Glaucoma Research
Background:
- Primary congenital glaucoma (PCG) is a severe form of childhood glaucoma.
- Understanding the histopathological basis of PCG is crucial for effective management and prognosis.
Purpose of the Study:
- To correlate histopathological changes in the trabecular meshwork (TM) with clinical features in primary congenital glaucoma (PCG).
Main Methods:
- Prospective interventional study of 66 eyes from 39 PCG children (≤12 months at diagnosis).
- Assessed corneal clarity, diameter, intraocular pressure (IOP), and cup disc ratio (C:D ratio) at baseline and 1-year follow-up.
- Light microscopy evaluated TM specimens for eosinophilic membrane (EM), trabecular beams, endothelial cells (TEC), intervening spaces, TM thickness, and TEC count.
Main Results:
- Reduced IOP and C:D ratio at 1-year follow-up.
- EM presence associated with lower baseline IOP; fused beams with higher baseline IOP.
- Thicker TM observed in eyes with presenting IOP >20 mm Hg; lower TEC count in eyes with final IOP ≤14 mm Hg.
Conclusions:
- Light microscopic analysis of surgical TM specimens may aid in predicting PCG prognosis.
- Larger studies are needed to validate these histopathological correlations in PCG.
Purpose:
To correlate histopathological changes of trabecular meshwork (TM) with clinical features in primary congenital glaucoma (PCG).
Methods:
This was a prospective interventional study including 66 eyes of 39 PCG children aged ≤12 months at diagnosis. Corneal clarity, corneal diameter (CD), intraocular pressure (IOP) and cup disc ratio (C:D ratio) were assessed at baseline and at 1-year follow-up. The trabecular meshwork (TM) specimens obtained during primary combined trabeculectomy and trabeculotomy augmented with Mitomycin-C were evaluated on light microscopy to look for eosinophilic membrane (EM), status of trabecular beams and trabecular endothelial cells (TEC), presence of intervening spaces, TM thickness and TEC count which were then correlated with clinical features.
Results:
At 1-year follow-up, IOP reduced from 27.96±10.2 to 11.88±5.63 mm Hg, p<0.001, C:D ratio decreased from 0.65±0.34 to 0.49±0.06, p=0.036, and the bleb had a significant tendency to change from well formed (59-46) to flat type (3-6) or thin, cystic type (4-14) (p=0.014). Presence of EM on the cameral surface was associated with a lower baseline IOP. Fused trabecular beams were associated with higher baseline IOP. The TM was significantly thicker in eyes with IOP >20 mm Hg at presentation (1.86±0.7 mm vs 1.3±0.47 mm, p=0.0356). Eyes with IOP ≤14 mm Hg at final follow-up had lower TEC count than eyes with IOP >14 mm Hg (0.92±0.45 cells/mm2 vs 1.00±0.74 cells/mm2, p=0.0028).
Conclusion:
A light microscopic analysis of surgical specimens may guide prognosis of PCG. However, larger studies are required to validate these results.
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