Читать книгу Essentials of Veterinary Ophthalmology - Kirk N. Gelatt - Страница 48

Aqueous humor is produced by the ciliary body epithelium and enters the posterior chamber before flowing through the pupil into the anterior chamber. In the conventional outflow pathway, aqueous humor exits the eye primarily through the corneoscleral trabecular (pressure sensitive) meshwork.

The anatomy of the aqueous humor outflow system has been extensively studied in humans, nonhuman primates, dogs, cats, rabbits, horses, and other ungulate species. This system primarily consists of the ICA, which is bounded anteriorly by the peripheral cornea and perilimbal sclera, and posteriorly by the peripheral iris and anterior ciliary body muscle. From amphibians to higher mammals, the ICA consists of an irregular, reticular network of connective tissue beams called trabeculae that are lined partially or entirely by a single layer of cells. The size of the ICA varies among species. In dogs of different ages and breeds that had undergone cataract surgeries, the size of the ICA as determined by the angle opening distance (the distance between the internal limbus and the base of the iris) using ultrasound biomicroscopy was found to vary considerably.

The pectinate ligaments consist of long strands anchoring the anterior base of the iris to the inner peripheral cornea (Figures 1.39 and 1.40). In the dog and cat, these strands are usually slender and widely separated from each other, thus making it difficult to visualize histologically an intact pectinate ligament fiber for its entire length. In contrast, most ungulates possess moderately broad to very stout pectinate ligaments. The pectinate ligaments are entirely lined by cells that are confluent with the anterior surface of the iris. Posteriorly, the pectinate ligament anastomoses with anterior beams of the trabecular meshwork that is divided into the uveal trabecular meshwork, which in most animals comprises most of the inner ICA area, thus forming the ciliary cleft, and the corneoscleral trabecular meshwork, which is similar in construction to the uveal meshwork but smaller in size of both the trabecular beams and the channels or spaces between the cell‐lined beams (the main area of resistance to the outflow of aqueous humor outflow). The uveal meshwork interconnects the inner, anterior ciliary body muscle with the pectinate ligament.

Figure 1.39 Gonioscopic view of the anterior ciliary body shows the fibrous strands, known as the pectinate ligaments, that attach the anterior base of the iris to the limbus.

Figure 1.40 Frontal view SEM of the canine ICA. Fibrous pillars that attach the iris (I) to the limbus form the pectinate ligaments (PL). Arrows indicate smaller fibrous connections between these pillars and uveal trabeculae located behind the pectinate ligament. (Original magnification, 160×.)

The corneoscleral trabecular meshworks of domestic animals are characterized mainly by small trabeculae separated by small intertrabecular spaces. In carnivores, these trabeculae are incompletely lined by trabecular cells. Composition of the trabeculae varies very little among species. The core, or center, of each beam is made up of circularly and meridionally oriented collagen fibers interspersed with a modified elastin. The core is usually enveloped by a cortical zone consisting of amorphous, granular material surrounded by basement membrane‐like material. Trabecular cells are similar across species, being fibroblast‐like with slender cell processes that attach to adjacent cells and their processes. These processes allow the corneoscleral trabecular meshwork to act as a sieve, thus reducing the size of the particles that can move into the meshwork. The trabecular cell also has the ability to ingest a wide variety of particles, which can range greatly in size. The phagocytic‐like quality of the trabecular cell provides the ICA with an indigenous clearance mechanism for debris, thus reducing possibilities for an inflammatory response. An operculum is located within the canine trabecular meshwork, and comprises much of the nonfiltering portion of the anterior trabecular meshwork (Figure 1.41).

The external boundary of the corneoscleral trabecular meshwork is formed by the sclera and a plexus of aqueous humor collector vessels. In mammals and most lower vertebrates, the aqueous humor chiefly exits the eye through the trabecular meshworks into these vessels. In most mammals, these vessels consist of a small network of veins collectively termed the AAP. These vessels have radially oriented lumens, differing from the circumferentially coursing canal of Schlemm in primates. The plexiform nature of the drainage vessels in most mammals allows removal of a substantial amount of aqueous humor.

The size of the individual collector vessels (i.e., trabecular veins) and the tissue immediately adjacent to the AAP varies considerably among mammals. The trabecular veins in cattle, sheep, and water buffalo are large and extensive. Those associated with dogs, cats, pigs, and horses are less prominent but are still extensive.

The manner by which aqueous humor flows into the trabecular veins of the AAP or canal of Schlemm is not completely understood. Most of the aqueous humor is thought to move through large, vacuole‐like structures of the inner endothelial cells.

Figure 1.41 Cells associated with the operculum in the dog form clusters and can be linearly arranged (Schwalbe's line cells [SLC]) within the anteriormost regions of the corneoscleral trabecular meshwork. O, operculum. (Original magnification, 9800×.)

The area adjacent to the trabecular veins typically consists of a zone of cellular elements intermixed with irregularly arranged elastin, collagen, and basement membrane‐like material. In some species, including dogs, rats, rabbits, and humans, smooth muscle‐like cells (myofibroblastic cells) have been observed in the trabecular meshwork, especially adjacent to the aqueous humor outflow channels and along the distal or outer walls of the AAP and Schlemm's canal. In the dog, the presence of myofibroblastic cells within the ICA suggests that these cells and the smooth muscle cells of the ciliary body along the same plane of orientation function to facilitate the removal of aqueous humor and are likely to be influenced by vascular mediators.