Skip to main content
SpringerLink
Log in

The mechanism of aqueous outflow following trabeculectomy

A light and electron microscopic study

  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

The morphological effects of trabeculectomy, performed as therapy for a case of chronic simple glaucoma, are described in the two eyes of a patient ten and thirteen months after treatment. Ten months after surgery, a transscleral channel, extending from the position formerly occupied by Schlemm's canal to the conjunctiva, is found. This channel is formed from a network of extended fibroblasts and loosely-packed collagenous tissue, and a large number of vessels, including both dilated blood capillaries and lymphatic vessels, develop within it. The sclera and subconjunctiva react differently to the presence of the nylon sutures. The findings support the hypothesis that the formation of an intrascleral outflow route stimulated by surgical intervention plays an important role in lowering IOP after trabeculectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bárány EH, Linnér E, Lütjen-Drecoll E, Rohen JW. Structural and functional effects of trabeculectomy in cynomolgus monkeys. Graefes Arch Klin Exp Ophthalmol 1972; 184: 1–28.

    Article  Google Scholar 

  2. Benedikt O. Zur Wirkungsweise der Trabekulektomie. Klin Monatsbl Augenheilkd 1975; 167: 679–85.

    PubMed  Google Scholar 

  3. Benedikt O. Die Darstellung des Kammerwasserabflusses normaler und Glaukomkranker menschlicher Augen durch Füllung der Vorderkammer mit Fluorescin. Graefes Arch Klin Exp Ophthalmol 1976; 199: 45–67.

    Article  Google Scholar 

  4. Cairns JE. Trabeculectomy. Trans Am Acad Ophthalmol Otolaryngol 1971; 75: 1395–6.

    Google Scholar 

  5. Cairns JE. Surgical treatment of primary open-angle glaucoma. Trans Ophthalmol Soc UK 1972; 92: 745–56.

    PubMed  Google Scholar 

  6. Cairns JE. Trabeculectomy: Preliminary report of a new method. Am J Ophthalmol 1988; 66: 673–9.

    Google Scholar 

  7. Fankhauser F, van der Zypen E, Kwasniewska S. Thermal effects on the trabecular meshwork induced by laser irradiation: clinical implications deduced from ultrastructural studies on the Macaca speciosa monkey. Trans Ophthalmol Soc UK 1986; 105: 555–61.

    PubMed  Google Scholar 

  8. Gloor BP, Piffaretti JM. Ausgewählte pathologische Befunde bei Trabeculectomie. Ophthalmologica 1975; 170: 108–14.

    PubMed  Google Scholar 

  9. Jerndal T, Kriisa V. Results of trabeculectomy for pseudoexfoliative glaucoma. Br J Ophthalmol 1974; 58: 927–30.

    PubMed  Google Scholar 

  10. Purnell WD, McPherson SD. Changes in scleral permeability after nonsurgical and operative manipulation. Presented at ARVO Spring Meeting, Sarasota, Fla, 1975.

  11. Rich AM, McPherson SD. Trabeculectomy in the owl monkey. Ann Ophthalmol 1973; 5: 1082–8.

    PubMed  Google Scholar 

  12. Ridgway AEA, Rubinstein K, Smith VH. Trabeculectomy. Br J Ophthalmol 1972; 56: 511–6.

    PubMed  Google Scholar 

  13. Shields MB, Shelburne JD, Bell SW. The ultrastructure of human limbal collagen. Invest Ophthalmol Vis Sci 1977; 16: 864–6.

    PubMed  Google Scholar 

  14. Shields MB, Bradbury MJ, Shelburne JD, Bell SW. The permeability of the outer layers of limbus and anterior sclera. Invest Ophthalmol Vis Sci 1977; 16: 866–9.

    PubMed  Google Scholar 

  15. Shields MB. Trabeculectomy vs full-thickness filtering operation for control of glaucoma. Ophthalmic Surg 1980; 11: 489–505.

    PubMed  Google Scholar 

  16. Spencer WH. Histologic evaluation of microsurgical glaucoma techniques. Trans Am Acad Ophthalmol Otolaryngol 1972; 76: 389–97.

    PubMed  Google Scholar 

  17. Taylor HR. A histologic survey of trabeculectomy. Am J Ophthalmol 1976; 82: 733–5.

    PubMed  Google Scholar 

  18. Thyer HW, Wilson P. Trabeculectomy. Br J Ophthalmol 1972; 56: 37–40.

    PubMed  Google Scholar 

  19. van der Zypen E, Fankhauser F. The ultrastructural features of laser trabeculopuncture and cyclodialysis. Problems related to a successful treatment of chronic simple glaucoma. Ophthalmologica 1979; 179: 189–200.

    PubMed  Google Scholar 

  20. van der Zypen E, Fankhauser F. Der Abfluss des Kammerwassers aus dem Spatium suprachorioideale nach Cyclodialyse. Fortschr Ophthalmol 1983; 79: 409–12.

    PubMed  Google Scholar 

  21. van der Zypen E, Fankhauser F. Ultrastructural changes in the trabecular meshwork of the monkey (Macaca speciosa) following irradiation with argon laser light. Graefes Arch Clin Exp Ophthalmol 1984; 221: 249–61.

    PubMed  Google Scholar 

  22. van der Zypen E. The effects of lasers on outflow structures. In: Krieglstein GK, ed. Glaucoma Update III. Berlin, Heidelberg: Springer Verlag, 1987: 169–76.

    Google Scholar 

  23. van der Zypen E, Fankhauser F, England C, Kwasniewska S. Morphology of the trabecular meshwork within monkey (Macaca speciosa) eyes after irradiation with the free-running Nd:YAG laser. Ophthalmology 1987; 94: 171–9.

    PubMed  Google Scholar 

  24. Watson PG, Barnett F. Effectiveness of trabeculectomy in glaucoma. Am J Ophthalmol 1975; 79: 831–45.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anatomy, University of Berne, Berne, Switzerland

    E. van der Zypen

  2. University Eye Clinic, Berne, Switzerland

    F. Fankhauser & S. Kwasniewska

Authors
  1. E. van der Zypen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Fankhauser
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Kwasniewska
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

The authors would like to dedicate this work to Prof. W. Lierse on his 60th birthday.

Rights and permissions

Reprints and permissions

About this article

Cite this article

van der Zypen, E., Fankhauser, F. & Kwasniewska, S. The mechanism of aqueous outflow following trabeculectomy. Int Ophthalmol 13, 219–228 (1989). https://doi.org/10.1007/BF02028215

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02028215

Key words

Search

Navigation