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Histological Analysis of Internal Trabecular Peeling and its Effect on Integrity of Schlemm´s Canal
1Roters S., 1Gavrilova B., 2Welsandt G., 2Radetzky S., 1Konen W.,
1Universität zu Köln, Zentrum für Augenheilkunde (Köln)
2Universität zu Köln, Zentrum für Augenheilkunde, Abteilung für Netzhaut- und Glaskörperchirurgie (Köln)
Purpose: During preparation of human eye bank eyes after trepanation of the corneoscleral button and separation of iris-lens diaphragm we observed that the internal trabecular meshwork (TMW) could be peeled off like trabecular stripping in deep sclerectomy with removal of external trabeculum. Does this mean complete removal of Schlemm´s canal bottom or just peeling of adjacent trabeculum leaving the endothelium intact?
Method: The internal TMW of corneoscleral slices (16mm) from 20 donor eyes (postmortem time <6 h) was partly removed (over two hours sector each) using a pair of fine scleral tweezers and marked for further preparation. We then excided the corneal graft after latest 36 hours; the remaining donor ring was formalin fixated for later histological examination. After incision of the trabecular meshwork in ten control slices Schlemms canal has been cannulated and subsequently peeled.
Results: In 65% (13 out of 20) Schlemms canal remained intact with 2-3 cell layers of the juxtacanalicular tissue still attached to the endothelium (range 1-6). In 15% (3 out of 20) the endothelial structure was interrupted without any continuous connection to the anterior chamber. 10% (2 out of 20) demonstrated a disruption of Schlemms canal with still adjacent endothelium. In further 10% and in all slices of the control group (n=10) Schlemms canal bottom structures have been completely removed.
Conclusions: In 80% of the tissues examined Schlemms canal remained intact after peeling of the trabecular meshwork. 10% showed disrupted endothelium without complete removal of the canals base; this might be also due to a histological artifact If external TMW-preparation during deep sclerectomy is similar to the internal technique described above, we strongly recommend the incision and cannulation of Schlemms canal for complete deroofing.