Argon laser trabeculoplasty. Studies of mechanism of action

The effects of argon laser trabeculoplasty (LTP) on outflow facility, Schlemm's canal morphology, trabecular cellularity, and trabecular glycosaminoglycan composition were determined in 33 pairs of eye-bank human eyes. At two levels of intraocular pressure, measured outflow facility did not immediately drop in response to LTP. Schlemm's canal distention was observed only at 40 mmHg intraocular pressure, where the canal normally tends to collapse. Trabecular cell density was reduced by about 40% in the eyes receiving laser treatment. The organ cultured trabecular meshworks in response to LTP altered their incorporation of 35S-sulfate, compared to controls, suggesting a change in the synthesis or turnover of the extracellular matrix of the trabeculum after trabeculoplasty. At least three potential mechanisms were identified in response to laser trabeculoplasty, including some mechanical distortion of the trabeculum at high intraocular pressures. We also hypothesize that laser trabeculoplasty dislodges some trabecular cells and may stimulate the remaining cells to renew more active synthesis and/or turnover of the trabecular extracellular matrix.