Samara State Medical University Regional Ophthalmic Hospital Samara, Russian Federation

Trabecular Meshwork Contribution to the Uveoscleral Outflow

Andrey V.Zolotaryov, MD, PhD Elena V.Karlova, MD Galina A.Nikolayeva April 28, 2020 ASCRS 2006 SanFrancisco 1

The authors have no financial interest in the subject matter of the presentation April 28, 2020 ASCRS 2006 SanFrancisco 2

April 28, 2020

Outflow(s?) Delimitation: Trabecular/Uveoscleral

A.Alm, 1997 • • • • • • • • • Bill A, Philipps CA, 1971 Jocson VL, Sears ML, 1971 Inomata H, Bill A., 1977 Sherman SH, Green K, Laties AM, 1978 A.Alm, 1997 Gaton DD et al., 1999 Weinreb RN, 2000 Lindsey JD, Weinreb RN, 2002 Kaufman PL, 2003 ASCRS 2006 SanFrancisco 3

Uveoscleral/Trabecular Outflow Morphology

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Purpose

• To specify the anterior chamber source of the uveoscleral outflow April 28, 2020 ASCRS 2006 SanFrancisco 5

Methods

• Autopsy human eyes • AC India ink perfusion • Microdissection – – – sclera drainage zone ciliary muscle • Histological sections April 28, 2020 ASCRS 2006 SanFrancisco 6

India Ink Perfusion

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Distribution of India Ink Within TM & CM

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Distribution of India Ink Within TM & CM

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Trabecular Meshwork Dissection Into Four Layers

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Layers of the Trabecular Meshwork 1 2 3

April 28, 2020 Zolotaryov AV , et al., Presented at AAO 2000 ASCRS 2006 SanFrancisco

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Layers of the Trabecular meshwork: Different Morphology&Function 1 3 2 4

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UVEAL Layers of the Trabecular meshwork: 2 3

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Sclero-Uveal Layer of TM: Function Scleral spur

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Uveal Layer of TM: Function

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Trabecular Meshwork Spaces and Fluid Motion

• Inter-trabecular spaces: the slits between the trabecular sheets • Intra-trabecular spaces: the holes within the trabecular sheets April 28, 2020 ASCRS 2006 SanFrancisco 16

Uveoscleral/Trabecular Outflow Morphology

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Uveoscleral Outflow Pathway: the Trabecular Source

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Conclusions

• Aqueous humor (AH) leaves the anterior chamber via trabecular meshwork in two directions:

trans

trabecular and

para

trabecular • Transtrabecular flow conveys AH into the Schlemm’s canal; paratrabecular flow continues into the uveoscleral pathway • Other structures of the anterior chamber play minor or no role in the AH outflow April 28, 2020 ASCRS 2006 SanFrancisco 19

…uncover new layers in October, 2006 Thank you for attention!

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