Elevated intraocular pressure is an important risk factor for the development of glaucoma, a leading cause of irreversible blindness. This ocular hypertension is due to increased hydrodynamic resistance to the drainage of aqueous humor through specialized outflow tissues, including the trabecular meshwork (TM) and the endothelial lining of Schlemm's canal. We know that glucocorticoid therapy can cause increased outflow resistance and glaucoma in susceptible individuals, that the cytoskeleton helps regulate aqueous outflow resistance, and that glucocorticoid treatment alters the actin cytoskeleton of cultured TM cells. Our purpose was to characterize the actin cytoskeleton of cells in outflow pathway tissues in situ, to characterize changes in the cytoskeleton due to dexamethasone treatment in situ, and to compare these with changes observed in cell culture. Human ocular anterior segments were perfused with or without 10(-7) M dexamethasone, and F-actin architecture was investigated by confocal laser scanning microscopy. We found that outflow pathway cells contained stress fibers, peripheral actin staining, and occasional actin "tangles." Dexamethasone treatment caused elevated IOP in several eyes and increased overall actin staining, with more actin tangles and the formation of cross-linked actin networks (CLANs). The actin architecture in TM tissues was remarkably similar to that seen in cultured TM cells. Although CLANs have been reported previously in cultured cells, this is the first report of CLANs in tissue. These cytoskeletal changes may be associated with increased aqueous humor outflow resistance after ocular glucocorticoid treatment.

This study showed for the first time that CLANs exist in cells of TM tissues from both normal and glaucomatous eyes that have not been manipulated by either tissue or organ culture procedures. It also provides quantitative data on CLAN prevalence in organized TM tissue, which indicates that CLANs are far more common than predicted (even from tissue culture) and there may be one in every cell in the glaucomatous TM in situ.

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Comprehensive understanding of the three-dimensional structure of the extracellular matrix (ECM) of the lamina cribrosa is central to understanding its role in health and disease, particularly how changes in configuration might precipitate nerve fibre death in glaucoma. Research until recently has relied almost entirely on light and scanning electron microscopy (SEM) to investigate the ECM of the lamina cribrosa. In this paper, we review the contribution of these methods to current understanding of the three-dimensional structure of the lamina ECM, highlight their potential weaknesses and emphasise that there is still much to be revealed about the structure of the lamina ECM. We then describe our development of confocal microscopy and computer reconstruction as a new and alternative method of investigating the three-dimensional structure of the lamina ECM. We show how optical sectioning allows the confocal microscope to acquire three-dimensional images of the lamina ECM without the degree of tissue disruption associated with preparation for SEM and demonstrate the versatility of analysis of these images by computer reconstructive software. A case is made for confocal microscopy and computer reconstruction contributing to our understanding of this important but complex and delicate structure.

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