Histological Findings in the Trabecular Meshwork of a Patient with Atopic Glaucoma



Satoru Kase1, 2, Shiki Chin1, *, Teruhiko Hamanaka3, Yasuhiro Shinmei1, Takeshi Ohguchi1, Riki Kijima1, Akira Matsuda4, Susumu Ishida1
1 Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University; N-15, W-7, Kita-ku, Sapporo 060-8638, Japan
2 Department of Ophthalmology, Teine Keijinkai Hospital; Maeda 1-12, Teine-ku, Sapporo 006-0811, Japan
3 Department of Ophthalmology, Japan Red Cross Society Medical Centre, Tokyo, Japan
4 Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan


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© 2017 Kase et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at Department of Ophthalmology, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo 060-8638, Japan; Tel: +81-11-706-5944; Fax: +81-11-706-5948; E-mail: schin@med.hokudai.ac.jp


Abstract

Purpose:

The aim of this study was to report a case of atopic dermatitis showing elevated intraocular pressure (IOP) beyond the baseline levels followed by a modified 360-degree suture trabeculotomy, and to analyze the histological findings in the trabecular meshwork.

Methods:

A 40-year-old male suffered from blurred vision in the right eye (OD). He had a medical history of severe atopic dermatitis and intraocular lens implantation OU due to atopic cataract. At the initial presentation, the visual acuity was 0.03, and IOP was 35 mmHg OD. Slit-lamp examination demonstrated corneal epithelial edema OD. Increased IOP was refractory to several topical medications. The patient underwent a modified 360-degree suture trabeculotomy. The visual field defect, however, deteriorated with persistently high IOP. The patient underwent trabeculectomy together with drainage implant surgery. In the outflow routes, although there seemed to be an opening of Schlemm’s canal into the anterior chamber, there was no endothelium of the canal in the region of its opening. The fibrotic changes were conspicuous around Schlemm’s canal.

Conclusion:

The histological results indicated that trabeculotomy might not be an appropriate treatment for patients with atopic glaucoma, possibly because of excessive repair to the newly created uveoscleral outflow in addition to the increased postoperative fibrosis in the trabecular meshwork and Schlemm’s canal.

Keywords: Atopic glaucoma, Trabeculotomy, Histopathology, Intraocular pressure, Postoperative fibrosis, Trabecular meshwork.