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Schlemm’s Canal and Collector Channels as Therapeutic Targets

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Surgical Innovations in Glaucoma

Abstract

Intraocular pressure (IOP) is maintained within a normal range from a dynamic balance between aqueous humor formation and drainage. Dysfunctional aqueous drainage results in elevated IOP, which is a causative risk factor for the development and progression of primary open-angle glaucoma (POAG). An understanding of how to lower IOP using microinvasive glaucoma surgery (MIGS) begins with an understanding of the normal anatomy of the structures related to the drainage of aqueous humor and changes in POAG. The major drainage structures for aqueous humor are the conventional or trabecular outflow pathway, which is comprised of the uveal and corneoscleral portions of the trabecular meshwork, the juxtacanalicular connective tissue, Schlemm’s canal, the collector channels, and the aqueous veins. Aqueous humor drains from the anterior chamber through progressively smaller channels of the trabecular meshwork into a circumferencely oriented channel called Schlemm’s canal. From this canal, circuitous channels weave toward the surface of the sclera, ultimately joining the episcleral vasculature which drains into the venous system. Flow through this system is driven by a bulk-flow pressure gradient, and active transport is not involved as neither metabolic poisons nor temperature affects this system to any significant degree. 10–20 % of total aqueous outflow has been reported to leave the normal eye via the uveoscleral pathway which has become a primary target for medical intervention in glaucoma. However, this chapter will only focus on the conventional trabecular outflow pathway.

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Acknowledgements

The original work reported in this chapter was supported in part by NIH/EY018712, EY022634, the American Health Assistance Foundation (now called BrightFocus Foundation), and the Massachusetts Lions Eye Research Fund.

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Correspondence to Haiyan Gong MD, PhD .

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Gong, H., Francis, A. (2014). Schlemm’s Canal and Collector Channels as Therapeutic Targets. In: Samples, J.R., Ahmed, I.I.K. (eds) Surgical Innovations in Glaucoma. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8348-9_1

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