The site of outflow resistance leading to elevated intraocular pressure in primary open angle glaucoma is believed to be located in the region of Schlemm's canal inner wall endothelium, its basement membrane and the adjacent juxtacanalicular tissue. Evidence also suggests collector channels and intrascleral vessels may have a role in intraocular pressure in both normal and glaucoma eyes. Traditional imaging modalities limit the ability to view both proximal and distal portions of the trabecular outflow pathway as a single unit. In this study, we examined the effectiveness of three-dimensional micro-computed tomography (3D micro-CT) as a potential method to view the trabecular outflow pathway. Two normal human eyes were used: one immersion fixed in 4% paraformaldehyde, and one with anterior chamber perfusion at 10 mmHg followed by perfusion fixation in 4% paraformaldehyde/2% glutaraldehyde. Both eyes were postfixed in 1% osmium tetroxide, and scanned with 3D micro-CT at 2 µm or 5 µm voxel resolution. In the immersion fixed eye, 24 collector channels were identified with an average orifice size of 27.5 ± 5 µm. In comparison, the perfusion fixed eye had 29 collector channels with a mean orifice size of 40.5 ± 13 µm. Collector channels were not evenly dispersed around the circumference of the eye. There was no significant difference in the length of Schlemm's canal in the immersed versus the perfused eye (33.2 versus 35.1 mm). Structures, locations and size measurements identified by 3D micro-CT were confirmed by correlative light microscopy. These findings confirm 3D micro-CT can be used effectively for the non-invasive examination of the trabecular meshwork, Schlemm's canal, collector channels and intrascleral vasculature that comprise the distal outflow pathway. This imaging modality will be useful for noninvasive study of the role of the trabecular outflow pathway as a whole unit.

Purpose To determine whether preferential pathways exist within the human trabecular meshwork, pigmented and nonpigmented regions adjacent to and between collector channels were examined, and the configuration of the juxtacanalicular tissue (JCT) was analyzed. Methods Healthy whole human eyes were perfused at 10 or 25 mm Hg with 0.5 μm fluorescent beads. Tissue wedges of pigmented and nonpigmented meshwork (with and without collector channels) were dissected from each eye and examined by confocal microscopy. Bead concentration adjacent to and between collector channels was quantified. The configuration of the JCT adjacent to collector channels from whole eyes perfused at 20 mm Hg was analyzed by light microscopy. Results Eyes perfused at 25 mm Hg had more beads adjacent to collector channels in pigmented than in nonpigmented regions (4.9% ± 3.5% vs. 1.1% ± 0.9%; P = 0.02). In pigmented regions without collector channels, bead concentration was decreased by fivefold (4.9% ± 3.5% vs. 0.96% ± 0.88%; P = 0.04). Perfusion at 25 mm Hg increased beads by threefold under pigmented collector channels compared with the same regions in eyes perfused at 10 mm Hg. Expansion of the JCT occurred more often under collector channels at 25 mm Hg than at 10 mm Hg (44% vs. 17%; P = 0.01). The JCT region under collector channels was expanded compared with JCT regions between adjacent collector channels (1053 ± 424 μm2 vs. 571 ± 216 μm2; P < 0.001). Conclusions Increased levels of beads in pigmented trabecular meshwork adjacent to collector channels suggest preferential flow pathways are present in human trabecular meshwork. At elevated pressure, the JCT region under collector channels is expanded, possibly because of increased fluid flow.

Compensatory mechanisms for transient and short periods of increased pressure appear to be diminished in POAG eyes. Variable response to pressure change in SC and CCs may be a contributing factor to outflow facility change in POAG eyes.

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Prostaglandins increase outflow facility in perfusion organ culture of human anterior segments. MMP activity was not consistently increased, and scleral hydraulic conductivity was not increased sufficiently to account for total facility increase. The histologic changes suggest a direct trabecular meshwork effect.