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In open-angle glaucoma, the iridocorneal angle remains open, but the trabecular meshwork becomes stiff, slowing down the outflow of aqueous humor. This causes a buildup of aqueous humor in the anterior chamber, leading to a sudden increase in intraocular pressure. The treatment for open-angle glaucoma focuses on reducing the elevated intraocular pressure by either decreasing the secretion of aqueous humor or increasing its outflow.
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Glaucoma is an eye condition characterized by increased intraocular pressure that damages the retina and optic nerve, leading to irreversible blindness if left untreated. The human eye has various components, including the cornea, iris, pupil, lens, and optic nerve. Aqueous humor is secreted by the epithelium of the ciliary body in the posterior chamber and flows through the trabecular meshwork and canal of Schlemm, maintaining normal intraocular pressure. The trabecular meshwork and the canal...
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Related Experiment Video

Updated: Jun 13, 2025

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Quantitative Evaluation of Trabecular Meshwork in Normal Tension Glaucoma Using Trabecular Meshwork Analyzing

Teruhiko Hamanaka1, Tetsuro Sakurai2, Takuji Kato3

  • 1From the Department of Ophthalmology, Japanese Red Cross Medical Center Shibuya-ku (T.H., T.F.), Tokyo.

American Journal of Ophthalmology
|May 5, 2025
PubMed
Summary

Normal-tension glaucoma (NTG) shows structural abnormalities in the trabecular meshwork (TM), challenging its status as a normal variant. Trabecular meshwork analysis software (TMAS) can help identify these changes and differentiate glaucoma types.

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Area of Science:

  • Ophthalmology
  • Glaucoma Research
  • Histopathology

Background:

  • Normal-tension glaucoma (NTG) is characterized by optic nerve damage and visual field loss despite normal intraocular pressure.
  • The role of the trabecular meshwork (TM) in NTG pathogenesis remains incompletely understood.
  • Trabeculectomy specimens offer a unique opportunity to study TM in vivo.

Purpose of the Study:

  • To investigate histologic changes in the trabecular meshwork (TM) of normal-tension glaucoma (NTG) patients.
  • To evaluate the utility of trabeculectomy specimens from NTG patients as controls for high-tension glaucoma analysis using TM analysis software (TMAS).

Main Methods:

  • A prospective comparative case series analyzing trabeculectomy specimens from 23 NTG patients and 12 autopsy eyes.
  • Light microscopy and TM analysis software (TMAS) were used to assess TM spaces, cellularity, and pigment accumulation.
  • TMAS1 evaluated regional variations (anterior, middle, posterior) in juxtacanalicular tissue (JCT), corneoscleral meshwork (CSM), and uveal meshwork (UVM), while TMAS2 measured total areas.

Main Results:

  • NTG patients presented with myopia, long axial length, advanced visual field defects, prolonged glaucoma medication use, and subnormal outflow facility.
  • TMAS2 revealed significantly reduced TM spaces (JCT, CSM) and lower TM cell counts (JCT, UVM) in NTG specimens compared to autopsy eyes.
  • No notable differences in TM space measurements were observed between TMAS1 and TMAS2 in NTG eyes.

Conclusions:

  • Histologic abnormalities in the TM are present in NTG, indicating it is not a normal variant.
  • These TM irregularities may be less pronounced than in high-tension glaucoma but contribute to disease progression.
  • TMAS2 is a valuable tool for analyzing TM in NTG and potentially differentiating various types of high-tension glaucoma using trabeculectomy specimens.