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New Results on Functional Morphology of the Choroid and its Changes in Glaucoma Disease
Lütjen-Drecoll E., May C.-A.,
Friedrich-Alexander-Universität Erlangen-Nürnberg, Anatomisches Institut LS II (Erlangen)
Purpose: To investigate whether choroidal ganglion cells (CGC) undergo morphological changes in human glaucomatous eyes different from changes occurring during normal aging.
Methods: 21 human glaucomatous eyes (11 with primary open angle glaucoma, 10 with pseudoexfoliation glaucoma; donor age 60-98 years) and 50 normal human eyes (donor age between the 25th week of pregnancy and 95 years) were investigated. Scleral and choroidal whole mounts of 37 normal eyes and of 13 eyes with glaucoma history were stained for NADPH diaphorase. The number of CGC was quantified in the different quadrants and in the suprachoroid separate from the remaining choroid. The size of the CGC was measured in the central and peripheral choroid separately. Serial semi- and ultra-thin sections were performed in additional 8 glaucomatous and 13 age-matched normal human eyes and studied by light and electron microscopy.
Results: In normal human eyes, the number of CGC remained constant during lifetime. The size of CGC increased up to adulthood and remained constant during further aging. In glaucomatous eyes, the number of CGC was significantly decreased and the remaining neurons revealed a larger cell size. The percentage of CGC in the suprachoroid compared to the remaining choroid was the same in normal and glaucomatous eyes, but only few neurons were present in the central choroid. The remaining CGC showed no ultrastructural abnormalities.
Conclusions: Although the number of CGC in glaucoma is reduced, the remaining cells reveal a normal morphology with no signs of apoptosis, necrosis or increased stress. The change in cell size of CGC in glaucoma might indicate a higher vulnerability of smaller CGC. The described changes point to a choroidal dysfunction in glaucoma that might support a vitious circle.