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. 2000 Jan;84(1):48–53. doi: 10.1136/bjo.84.1.48

Membrane formation in the chamber angle after failure of argon laser trabeculoplasty: analysis of risk factors

T Koller 1, J Sturmer 1, C Reme 1, B Gloor 1
PMCID: PMC1723232  PMID: 10611099

Abstract

AIM—Membrane formation in the chamber angle induced by argon laser trabeculoplasty (ALT) can be a cause of treatment failure. Identification of risk factors for membrane formation was the primary aim of this retrospective study.
METHODS—Semithin sections of trabeculectomy specimens obtained in a 2 year period were examined by light microscopy. 122 eyes which were treated with one or more ALTs before trabeculectomy were identified. In 46 eyes, a sufficient amount of trabecular meshwork was obtained to permit morphological analysis.
RESULTS—Eyes treated with ALT had a significantly higher incidence of membrane formation (p=0.001). In 23/46 specimens a cellular and collagenous membrane was observed covering the entire trabecular meshwork. In 14/23 specimens (61%), this membrane was readily visible at low power magnification (×40). Comparison of these eyes with those without membrane formation revealed a significant difference in the number of ALTs (mean 2.07 (SD 0.73) v 1.48 (0.59); p=0.026) and in preoperative IOP (32.0 (9.7) v 26.2 (8.4) mm Hg; p=0.04).
CONCLUSIONS—Membrane formation in the chamber angle is a frequent cause of ALT failure. The major risk factor is the number of ALTs performed.



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Figure 1  .

Figure 1  

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Low power light micrograph depicting a normal chamber angle region. Schlemm's canal (S), the trabecular meshwork (T), parts of the ciliary muscle (C), and the iris (I). Original magnification ×10.

Figure 2  .

Figure 2  

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Light micrograph showing the Schlemm's canal (S) and the trabecular meshwork (T). A membrane (arrows) extends over the meshwork, intertrabecular spaces are narrow. Original magnification ×40.    

Figure 3  .

Figure 3  

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High power light micrograph illustrating a distinct membrane (arrow) extending over the trabecular meshwork. The intertrabecular spaces are obliterated, large fibrocytic cells (F) and pigment granules (P) appear within the meshwork. Original magnification ×100.    

Figure 4  .

Figure 4  

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Light micrograph showing the region of Schwalbe's line and the anterior trabecular meshwork. Newly formed collagen (*) and fibrocytic cells (F) are seen. Original magnification ×100.

Figure 5  .

Figure 5  

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Electron micrograph showing newly formed collagen fibrils (*) in the region of the membrane covering the trabecular meshwork. Original magnification ×10 000.    

Figure 6  .

Figure 6  

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Electron micrograph demonstrating collagen formation (*) in the anterior meshwork area. F = activated fibrocyst. Original magnification ×5000.    

Figure 7  .

Figure 7  

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Membrane formation and ALT.    

Figure 8  .

Figure 8  

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Histology. Membrane formation, collagen fibrils, pseudoexfoliative material, amount of pigment, and endothelial cells in the trabecular meshwork compared in eyes with and without ALT. Eyes with ALT have significantly more membranes over the trabecular meshwork (p=0.001) than eyes without.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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