A common pathway for developmental glaucomas

In a clinicopathologic study of ten patients, utilizing a modified trabeculectomy technique for acquisition of histologic specimens, a high insertion of the iris was observed in four types of developmental glaucoma. A survey of the literature revealed additional developmental disorders with this abnormality of the anterior chamber angle. The common defect is believed to arise from a developmental arrest during the third trimester of gestation of tissues derived from cranial neural crest cells. The mechanism by which this developmental defect leads to aqueous outflow obstruction may, in some cases, be a paradoxical collapse of the trabecular meshwork and Schlemm's canal in response to contraction of the ciliary musculature, while other patients may have additional developmental abnormalities in the aqueous outflow system as the possible mechanism of glaucoma.