Samara State Medical University Regional Ophthalmic Hospital Samara

Samara State Medical University Regional Ophthalmic Hospital Samara, Russian Federation Trabecular Meshwork Contribution to the Uveoscleral Outflow Andrey V. Zolotaryov, MD, Ph. D Elena V. Karlova, MD Galina A. Nikolayeva 1/2/2022 ASCRS 2006 San. Francisco 1

The authors have no financial interest in the subject matter of the presentation 1/2/2022 ASCRS 2006 San. Francisco 2

Outflow(s? ) Delimitation: Trabecular/Uveoscleral A. Alm, 1997 1/2/2022 ASCRS 2006 San. Francisco • 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 3

Uveoscleral/Trabecular Outflow Morphology ? 1/2/2022 ASCRS 2006 San. Francisco 4

Purpose • To specify the anterior chamber source of the uveoscleral outflow 1/2/2022 ASCRS 2006 San. Francisco 5

Methods • Autopsy human eyes • AC India ink perfusion • Microdissection – sclera – drainage zone – ciliary muscle • Histological sections 1/2/2022 ASCRS 2006 San. Francisco 6

India Ink Perfusion 1/2/2022 ASCRS 2006 San. Francisco 7

Distribution of India Ink Within TM & CM 1/2/2022 ASCRS 2006 San. Francisco 8

Distribution of India Ink Within TM & CM 1/2/2022 ASCRS 2006 San. Francisco 9

Trabecular Meshwork Dissection Into Four Layers 1/2/2022 ASCRS 2006 San. Francisco 10

Layers of the Trabecular Meshwork 1 2 3 Zolotaryov AV, AV et al. , Presented at AAO 2000 1/2/2022 ASCRS 2006 San. Francisco 4 11

Layers of the Trabecular meshwork: Different Morphology&Function 1 1/2/2022 2 3 ASCRS 2006 San. Francisco 4 12

UVEAL Layers of the Trabecular meshwork: 2 1/2/2022 3 ASCRS 2006 San. Francisco 13

Sclero-Uveal Layer of TM: Function Scleral spur 1/2/2022 ASCRS 2006 San. Francisco 14

Uveal Layer of TM: Function 1/2/2022 ASCRS 2006 San. Francisco 15

Trabecular Meshwork Spaces and Fluid Motion • Inter-trabecular spaces: the slits between the trabecular sheets • Intra-trabecular spaces: the holes within the trabecular sheets 1/2/2022 ASCRS 2006 San. Francisco 16

Uveoscleral/Trabecular Outflow Morphology ? 1/2/2022 ASCRS 2006 San. Francisco 17

Uveoscleral Outflow Pathway: the Trabecular Source 1/2/2022 ASCRS 2006 San. Francisco 18

Conclusions • Aqueous humor (AH) leaves the anterior chamber via trabecular meshwork in two directions: transtrabecular and paratrabecular • 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 1/2/2022 ASCRS 2006 San. Francisco 19

…uncover new layers in October, 2006 Thank you for attention! 1/2/2022 ASCRS 2006 San. Francisco 20