The trabecular meshwork outflow pathways: Structural and functional aspects

The major drainage structures for aqueous humor (AH) are the conventional or trabecular outflow pathways, which are comprised of the trabecular meshwork (made up by the uveal and corneoscleral meshworks), the juxtacanalicular connective tissue (JCT), the endothelial lining of Schlemm's canal (SC), the collecting channels and the aqueous veins. The trabecular meshwork (TM) outflow pathways are critical in providing resistance to AH outflow and in generating intraocular pressure (IOP). Outflow resistance in the TM outflow pathways increases with age and primary open-angle glaucoma. Uveal and corneoscleral meshworks form connective tissue lamellae or beams that are covered by flat TM cells which rest on a basal lamina. TM cells in the JCT are surrounded by fibrillar elements of the extracellular matrix (ECM) to form a loose connective tissue. In contrast to the other parts of the TM, JCT cells and ECM fibrils do not form lamellae, but are arranged more irregularly. SC inner wall endothelial cells form giant vacuoles in response to AH flow, as well as intracellular and paracellular pores. In addition, minipores that are covered with a diaphragm are observed. There is considerable evidence that normal AH outflow resistance resides in the inner wall region of SC, which is formed by the JCT and SC inner wall endothelium. Modulation of TM cell tone by the action of their actomyosin system affects TM outflow resistance. In addition, the architecture of the TM outflow pathways and consequently outflow resistance appear to be modulated by contraction of ciliary muscle and scleral spur cells. The scleral spur contains axons that innervate scleral spur cells or that have the ultrastructural characteristics of mechanosensory nerve endings.     

Localization of smooth muscle and nonmuscle actin isoforms in the human aqueous outflow pathway.

alpha-Smooth muscle actin is the isoform of actin restricted to vascular smooth muscle, pericytes, myofibroblasts and, certain other cells that are of myoid origin. We investigated the distribution of alpha-smooth muscle actin and nonmuscle specific filamentous actin in the human aqueous outflow system by immunohistochemical methods. Filamentous actin was observed in all cellular constituents of the outflow pathway, while distribution of alpha-smooth muscle actin was restricted to the ciliary muscle, to specific cells throughout the trabecular meshwork, and to cells adjacent to the outer wall and the collector channels. The ciliary muscle extended deep into the corneoscleral meshwork, far anterior to the scleral spur. These findings agree with our previous study localizing the distribution of smooth muscle myosin in the human aqueous outflow pathway. Although functionality of the immunoreactive cells needs to be demonstrated, our data show that a potentially contractile apparatus exists in a subpopulation of trabecular meshwork cells and in certain cells of the more distal components of the outflow system.     

Low doses of pilocarpine do not significantly increase outflow facility in the cynomolgus monkey

Low doses (10(-9)-10(-6) M) of pilocarpine reportedly increase outflow facility in the organ-cultured human eye, suggesting a direct action on the trabecular meshwork. M3 muscarinic receptors have been found in both cultured human trabecular meshwork cells and tissue. We determined whether low pilo doses would increase outflow facility in the living monkey. The anterior chambers of both eyes of 17 pentobarbital anesthetized cynomolgus monkeys were cannulated and outflow facility measured bilaterally by 2-level constant pressure perfusion after an initial 2 ml exchange with Bárány's perfusand containing 24.5 microM phenylephrine (PE). Two subsequent exchanges were performed with one eye receiving Bárány's + PE + 10(-10)-10(-4) M pilocarpine and the contralateral eye receiving only Bárány's + PE. Outflow facility was measured for 35-40 min following each exchange. Accommodation and pupil diameter were measured before each exchange and approximately every 10 min during facility measurements. Outflow facility was significantly increased by 154 and 313% in eyes treated with 10(-5) M and 10(-4) M pilocarpine, respectively, related to contralateral controls. Accommodation and miosis also were induced only at 10(-5) M (accommodation, 3.3 +/- 1.6 diopters, NS; miosis, -4.1 +/- 0.5 mm, P < or = 0.001) and 10(-4) M (accommodation, 10.6 +/- 0.0 diopters, P < or = 0.02; miosis, -3.4 +/- 1.0 mm, P < or = 0.025) pilocarpine. We conclude that low anterior chamber doses of pilocarpine do not increase outflow facility in the living monkey as reported in the organ-cultured human eye, nor do they induce miosis or accommodation. All three parameters respond to pilocarpine at similar doses, and there is no functional evidence of a meaningful outflow facility-relevant pilocarpine effect on the trabecular meshwork at doses lower than those which affect the ciliary muscle.     

Direct involvement of trabecular meshwork in the regulation of aqueous humor outflow

Our new hypothesis for the regulation of aqueous humor outflow suggests that the trabecular meshwork is not a passive filter but an active contractile element contributing to the ciliary muscle traction affecting it. The trabecular meshwork contains contractile smooth-muscle-specific alpha-actin filaments, and its cells exhibit electrical properties typical for smooth muscle cells. Contractility measurements performed for the first time in isolated trabecular meshwork enable a functional comparison with ciliary muscle. Pharmacologic outflow regulation has been determined in isolated perfused anterior segments with intact trabecular meshwork and total absence of ciliary muscle. Substances that contracted isolated trabecular meshwork (e.g., pilocarpine) decreased the outflow rate, whereas relaxants (e.g., low-dose epinephrine) increased it. The concept of a functional antagonism between the trabecular meshwork and the ciliary muscle has to be considered.     

Light and electron microscopy of the anterior chamber angle structures following surgical disinsertion of the ciliary muscle in the cynomolgus monkey.

Light and electron microscopic studies were done on 11 cynomolgus monkey eyes which had undergone total iris removal followed by surgical disinsertion of the ciliary muscle from the scleral spur 4.7 to 14.4 months earlier. Anterior chamber perfusion to measure gross outflow facility had been performed one to nine times postoperatively. Over most of the circumference in most eyes (1) the ciliary muscle had been retrodisplaced from the scleral spur and had reattached to the sclera more posteriorly; (2) ciliary muscle, trabecular meshwork, and Schlemm's canal appeared normal. A cyclodialysis cleft was never seen. Fixation of some eyes in the in vivo and in vitro presence of pilocarpine demonstrated the contractibility of the retrodisplaced muscle. In isolated areas where the ciliary body had been surgically cut, scar tissue of varying thickness connected scleral spur, sclera, ciliary body, zonule, and lens capsule, but did not infiltrate trabecular meshwork or Schlemm's canal. In such sectors, plasma cell-like cells replaced trabecular endothelial cells and were also present in the scar tissue, ciliary muscle, and surrounding vessel walls in the scar and sclera. In sectors of two eyes, a previously existing trabecular operculum extended posteriorly and completely covered the meshwork. The meshwork in these sectors was poorly perfused by aqueous humor, and electron-dense deposits were present beneath the inner wall of Schlemm's canal. Four totally iridectomized and two unoperated eyes from these monkeys were also examined; ciliary muscle, trabecular meshwork, and Schlemm's canal appeared normal in all, despite the numerous anterior chamber perfusions.     

Differential smooth muscle-like contractile properties of trabecular meshwork and ciliary muscle.

The contractile properties of bovine trabecular meshwork and ciliary muscle strips were investigated using an electromagnetic force-length transducer for isometric force measurements. Acetylcholine, pilocarpine and aceclidine administration resulted in dose-dependent contractions of trabecular meshwork and ciliary muscle. Absolute forces were approximately 10 times larger in ciliary muscle than in trabecular meshwork. Maximal force evoked by aceclidine (5 x 10(-5) M), when compared to the pilocarpine (5 x 10(-5) M) response, was significantly higher in trabecular meshwork than in ciliary muscle. The results were 172.5 +/- 12.6% (n = 7) and 138.9 +/- 4.0% (n = 8, P less than 0.05), respectively. Depolarization induced by raised external potassium (120 mM), when compared to the acetylcholine response (10(-3) M), resulted in a small contraction of 19.3 +/- 4.2% in trabecular meshwork (n = 5), and of 59.0 +/- 13.7% in ciliary muscle (n = 4, P less than 0.01). Both responses were inhibited by atropine (10(-5) M). The differential potassium effect may be explained by the large number of cholinergic nerve endings in ciliary muscle as compared to trabecular meshwork tissue. Recently, a dissociation between the effects of aceclidine on outflow resistance and accommodation has been described. Our data are consistent with these observations and provide evidence for a direct role of trabecular meshwork contractility in aqueous outflow regulation.     

Direct effects of muscarinic agents on the outflow pathways in human eyes

PURPOSE: Recent studies demonstrating the presence of muscarinic receptors and contractile-like cells in the trabecular meshwork tissue and/or cell cultures from human eyes suggest the possibility that there may be a direct effect of muscarinic agonists on outflow facility. The present studies were conducted to determine whether muscarinic agonists could change outflow facility in perfused human ocular anterior segments, which lack an intact ciliary muscle. METHODS: Human eyes were dissected and perfused according to previously described methods. A steady state baseline facility was established for 90 minutes, after which up to four sequential concentrations ranging from 10(-9) to 10(-3) M of pilocarpine, aceclidine, or carbachol were added to the perfusion medium. In other studies, 10(-6) M atropine was perfused alone followed by 10(-7) M carbachol with 10(-6) M atropine, whereas fellow control eyes received carbachol alone. Outflow facility was measured for 60 minutes after each drug addition. The outflow facility measurement in each eye after drug administration was compared with the baseline measurement. RESULTS: Outflow facility increased from baseline facility in eyes treated with pilocarpine, aceclidine, or carbachol at lower concentrations (10(-9) to 10(-6) M) but remained unchanged at higher concentrations (10(-4) to 10(-2) M). The effects of carbachol at 10(-7) M were completely blocked by atropine. CONCLUSIONS: Muscarinic agonists increase outflow facility in human eyes by a direct stimulation of the outflow tissues in the absence of an intact ciliary muscle. This effect is biphasic, occurring at concentrations of 10(-6) M and lower with no effect at higher concentrations.     

Effects of the Rho kinase inhibitor Y-27632 and the phosphatase inhibitor calyculin A on outflow facility in monkeys

Previous studies have shown that the inhibition of Rho kinase is involved in the regulation of outflow facility in the live rabbit eye and the enucleated porcine eye. However, it is unknown whether the Rho kinase inhibition will do the same in non-human primates. To determine if the Rho kinase inhibitor Y-27632 will reduce outflow resistance in the live monkey eye, if Y-27632 and the phosphatase inhibitor calyculin A (Caly-A which antagonises Y-27632-induced MLC dephosphorylation) will affect outflow facility differently, and if the latter will inhibit effect of the former on facility, we studied effects of Y-27632 and Caly-A on outflow facility in living monkeys separately and concurrently. Total outflow facility was measured by 2-level constant pressure perfusion of the anterior chamber (AC) before and after exchange with different doses of Y-27632 (1, 10 and 100 microM) or Caly-A (10, 50 and 100 nM), or vehicles, followed by continuous AC infusion of corresponding drug/vehicle solution, in opposite eyes of cynomolgus or rhesus monkeys. The effect of 100 microM Y-27632 or 100 nM Caly-A vs vehicle and the effect of 100 microM Y-27632+100 nM Caly-A vs 100 microM Y-27632 alone on outflow facility were also determined in monkeys pre-treated topically with 10 microl of 1% atropine in both eyes 1 hr before perfusion. Both Y-27632 and Caly-A dose-dependently increased outflow facility by up to 2-3 fold in monkeys, adjusted for baseline and contralateral control eye washout. Pre-treatment with 1% topical atropine partially inhibited the effect of 100 nM Caly-A, but not 100 microM Y-27632, on outflow facility. 100 nM Caly-A gradually and partially inhibited the Y-27632-induced facility increase. In conclusion, Y-27632 increases outflow facility in monkeys presumably by inhibiting cellular contractility in the TM. Caly-A increases outflow facility by complicated mechanisms perhaps including drug-induced ciliary muscle contraction and cytoskeletal reorganisation in TM cells. The partial inhibitory effect of Caly-A on the Y-27632-induced increase in outflow facility may reflect the former partially inhibiting the latter's relaxation of cells in the TM.     

A brief review of outflow facility from the viewpoint of metabolic inhibitors

Aqueous humor is generally considered to flow through the trabecular meshwork without requiring pumping energy from this tissue. Previous studies of the influence of metabolic inhibitors were done mostly at room temperature and usually showed no effect. However, we found that, when tested at 35-36 degrees C, F- reduced the facility of outflow of enucleated bovine eyes. Furthermore, F- did not significantly change the tone of the isolated bovine ciliary muscle, thus the mechanical opening of the trabecular meshwork "pore" could be eliminated. The author made a brief review in this article that outflow facility might happen to be altered by changes in cellular activity involving metabolic processes in the aqueous drainage system.     

Aqueous outflow regulation – 21st century concepts

We propose an integrated model of aqueous outflow control that employs a pump-conduit system in this article. Our model exploits accepted physiologic regulatory mechanisms such as those of the arterial, venous, and lymphatic systems. Here, we also provide a framework for developing novel diagnostic and therapeutic strategies to improve glaucoma patient care. In the model, the trabecular meshwork distends and recoils in response to continuous physiologic IOP transients like the ocular pulse, blinking, and eye movement. The elasticity of the trabecular meshwork determines cyclic volume changes in Schlemm's canal (SC). Tube-like SC inlet valves provide aqueous entry into the canal, and outlet valve leaflets at collector channels control aqueous exit from SC. Connections between the pressure-sensing trabecular meshwork and the outlet valve leaflets dynamically control flow from SC. Normal function requires regulation of the trabecular meshwork properties that determine distention and recoil. The aqueous pump-conduit provides short-term pressure control by varying stroke volume in response to pressure changes. Modulating TM constituents that regulate stroke volume provides long-term control. The aqueous outflow pump fails in glaucoma due to the loss of trabecular tissue elastance, as well as alterations in ciliary body tension. These processes lead to SC wall apposition and loss of motion. Visible evidence of pump failure includes a lack of pulsatile aqueous discharge into aqueous veins and reduced ability to reflux blood into SC. These alterations in the functional properties are challenging to monitor clinically. Phase-sensitive OCT now permits noninvasive, quantitative measurement of pulse-dependent TM motion in humans. This proposed conceptual model and related techniques offer a novel framework for understanding mechanisms, improving management, and development of therapeutic options for glaucoma.     

眼调节对葡萄膜巩膜房水外流途径影响的形态学观察

目的　通过形态学观察探讨眼调节对葡萄膜巩膜房水外流途径的影响。方法　14只健康日本大耳白兔,10只（20眼）用于荧光显微镜观察,4只（8眼）用于光镜观察,按用药方法不同各分为调节状态组和非调节状态组。所有白兔双眼分别采用5 g·L^-1硝酸毛果芸香碱滴眼液和10 g·L^-1盐酸环喷托酯滴眼液模拟眼调节态和非调节态,测量滴眼前及末次滴眼后30 min的眼压,于滴眼后30 min将5 μL异硫氰酸荧光素标记牛血清白蛋白（FITC-BSA）注入前房,于前房注射后0.5 h、1.5 h、2.5 h、3.5 h、4.5 h各处死2只白兔,摘取双眼作冰冻切片,于荧光显微镜下观察调节态和非调节态葡萄膜巩膜途径的房水荧光强度及其分布形态;于滴眼后30 min处死4只白兔,摘取双眼通过HE染色和抗平滑肌抗体染色在普通光镜下观察兔眼睫状肌形态、肌间隙。结果　调节状态组基线眼压（19.13±1.75）mmHg（1 kPa=7.5 mmHg),毛果芸香碱模拟眼调节后眼压下降,滴眼后眼压为（16.56±1.67）mmHg,差异有统计学意义（t=9.37,P=0.00)。调节状态组睫状体、脉络膜上腔和前巩膜荧光强度较非调节状态组均显著减弱（均为P<0.05）,而两组间后巩膜、脉络膜差异均无统计学意义（均为P＞0.05）。光镜观察见非调节状态组放射肌区域有明显肌间隙,而在调节状态组未发现此间隙。结论　眼调节可通过收缩睫状肌从而减少房水从葡萄膜巩膜房水外流道排出。     

The prostanoid EP2 receptor agonist butaprost increases uveoscleral outflow in the cynomolgus monkey

PURPOSE: To investigate the ocular hypotensive effect of the prostanoid EP2 receptor agonist butaprost and to establish its mechanism of action. METHODS: All experiments were performed in cynomolgus monkeys after topical application of butaprost (0.1%). The effects of butaprost on aqueous humor flow were determined by fluorophotometry. Total outflow facility was measured by the two-level, constant-pressure perfusion method, and uveoscleral outflow was determined by perfusion of FITC-labeled dextran through the anterior chamber. Effects on ocular morphology were studied after tissue fixation with transcardial perfusion by paraformaldehyde and immersion fixation of the globe, in animals subjected to long-term treatment with butaprost. Conscious ocular normotensive monkeys and monkeys with unilateral ocular hypertension were used for intraocular pressure (IOP) studies. RESULTS: Butaprost had no significant effect on aqueous humor flow or total outflow facility in ocular normotensive monkeys. Uveoscleral outflow was significantly higher in the butaprost treated eyes than in vehicle treated eyes, 1.03 +/- 0.20 vs. 0.53 +/- 0.18 microL.min(-1). After a 1-year treatment with butaprost, the morphology of the ciliary muscle was changed, showing increased spaces between ciliary muscle bundles and the apparent formation of new outflow channels. In many instances, changes were observed in the trabecular meshwork as well. Butaprost, in a single 0.1% dose, decreased IOP significantly in ocular normotensive monkeys and reduced IOP in laser-induced glaucomatous monkey eyes to the same level as that in the ocular normotensive contralateral eyes. CONCLUSIONS: The prostanoid EP2 receptor agonist butaprost appears to lower IOP by increasing uveoscleral outflow, according to both physiological and morphologic findings. Although the prostanoid EP2 receptor is structurally and functionally distinct from the FP receptor, the effects of EP2 and FP receptor stimulation on aqueous humor outflow are similar.     

The regulation of trabecular meshwork and ciliary muscle contractility

Current models of aqueous humor outflow no longer treat trabecular meshwork (TM) as an inert tissue passively distended by the ciliary muscle (CM). Instead, ample evidence supports the theory that trabecular meshwork possess smooth muscle-like properties and is actively involved in the regulation of aqueous humor outflow and intraocular pressure. In this model, trabecular meshwork and ciliary muscle appear as functional antagonists, with ciliary muscle contraction leading to a distension of trabecular meshwork with subsequent reduction in outflow. and with trabecular meshwork contraction leading to the opposite effect. Smooth-muscle relaxing substances would therefore appear to be ideal candidates for glaucoma therapy with the dual goal of reducing intraocular pressure via the trabecular meshwork and of improving vascular perfusion of the optic nerve head. However, for such substances to effectively lower intraocular pressure, the effect on the ciliary muscle would have to he minimal. For this reason, more information is needed on the signalling processes involved in regulating trabecular meshwork and ciliary muscle contractility. This review attempts to outline current knowledge of signal transduction pathways leading to relaxation and contraction of ciliary muscle and trabecular meshwork. Pathways can be classified as involving or not involving changes of membrane voltage and of requiring or not requiring external calcium: possibly, other pathways exist. These different pathways involve different ion channels and isoforms of PKC and are expressed to a differing degree in ciliary muscle and trabecular meshwork, leading to differential responses when exposed to relaxing or contracting pharmacological agents. Some of these agents. like tyrosine kinase inhibitors and inhibitors of PKC. have been shown to relax trabecular meshwork while leaving ciliary muscle comparatively unaffected. This profile makes these substances appear as ideal drugs for simultaneously improving ocular outflow and retinal circulation, parameters that determine the time course of visual deterioration in glaucoma.     

Scleral expansion band procedure: Therapy for ocular hypertension and primary open-angle glaucoma

The scleral expansion band procedure (SRP) reverses presbyopia and increses the baseline tension of the ciliary muscle, which increases the trabecular meshwork pore size. By increasing the pore size, SRP is a new therapeutic and preventive modality for ocular hypertension and primary open-angle glaucoma.     

Localization of smooth muscle myosin-containing cells in the aqueous outflow pathway

Cells containing smooth muscle myosin were localized in the human aqueous outflow pathway by immunohistochemical techniques. In the majority of eyes, immunoreactive cells were observed adjacent to the collector channels and slightly distal to the outer wall of Schlemm's canal. In a few eyes, smooth muscle myosin was localized to cells in the juxtacanalicular tissue and the trabecular meshwork. The immunoreactive cells from these regions may be true smooth muscle cells or pericytes, which can contain smooth muscle myosin. No obvious differences were observed in the pattern of distribution of smooth muscle myosin-containing cells in a comparison of age groups. In the majority of eyes, we observed an apparent direct insertion of the longitudinal portion of the ciliary muscle in the corneoscleral meshwork far internal to the scleral spur.     

Aqueous outflow - A continuum from trabecular meshwork to episcleral veins

In glaucoma, lowered intraocular pressure (IOP) confers neuroprotection. Elevated IOP characterizes glaucoma and arises from impaired aqueous humor (AH) outflow. Increased resistance in the trabecular meshwork (TM), a filter-like structure essential to regulate AH outflow, may result in the impaired outflow. Flow through the 360° circumference of TM structures may be non-uniform, divided into high and low flow regions, termed as segmental. After flowing through the TM, AH enters Schlemm's canal (SC), which expresses both blood and lymphatic markers; AH then passes into collector channel entrances (CCE) along the SC external well. From the CCE, AH enters a deep scleral plexus (DSP) of vessels that typically run parallel to SC. From the DSP, intrascleral collector vessels run radially to the scleral surface to connect with AH containing vessels called aqueous veins to discharge AH to blood-containing episcleral veins. However, the molecular mechanisms that maintain homeostatic properties of endothelial cells along the pathways are not well understood. How these molecular events change during aging and in glaucoma pathology remain unresolved. In this review, we propose mechanistic possibilities to explain the continuum of AH outflow control, which originates at the TM and extends through collector channels to the episcleral veins.     

The fate of anterior chamber flurescein in the monkey eye. 1. The anterior chamber outflow pathways.

As defined by freeze-dry tissue techniques, there are two distinct routes by which fluorescein leaves the anterior chamber of the living rhesus monkey eye. I. The conventional pathway: Within five minutes of the initiation of fluorescein perfusion through the anterior chamber, the conventional pathway filled. Tracer passed through the trabecular meshwork into Schlemm's canal, and flowed back within scleral and episcleral venous derivatives to enter large veins in the extraocular muscles. II. The uveo-vortex pathway: Fluorescein rapidly moved into the iris stroma and into the anterior part of the ciliary body. The anterior chamber border of the ciliary body is little more than a sparse mesh from which fluorescein entered directly into the substance of the anterior ciliary muscle. Fluorescein penetrated blood vessels in the iris stroma and in the anterior ciliary body from where it could be traced posteriorly to the equatorial choroid and vortex veins. The specific sequential tissue distribution of fluorescein strongly supports the existence of a uveo-vortex pathway for aqueous outflow.     

Targeting outflow facility in glaucoma management

Glaucoma is often characterized by decreased pressure-sensitive aqueous outflow through the trabecular meshwork. This defect in pressure-sensitive aqueous outflow is evident from the low tonographic facility of outflow ("C") measured in many patients. The impairment in outflow facility causes the high intraocular pressure (IOP) and large diurnal IOP fluctuations often found in glaucoma. Because large diurnal IOP fluctuations have been shown to be a risk factor for glaucomatous progression, IOP-lowering therapy should aim to achieve a low, stable IOP. Pressure-sensitive aqueous outflow helps prevent and dampen pressure spikes; thus, drugs that enhance outflow facility, in particular, may stabilize as well as lower IOP. Outflow facility is an attractive target for glaucoma treatment because enhancing outflow facility tends to restore the self-regulating tendency of IOP. Older drugs such as the cholinergic pilocarpine and the catecholamine epinephrine act primarily by improving outflow facility. This action is also important for the recently introduced prostamide, bimatoprost, as well as for the prostaglandin prodrug, latanoprost. Realization of the importance of facility of outflow in lowering and stabilizing IOP will stimulate additional research into the mechanism of action of ocular hypotensive agents and will help optimize the medical treatment of glaucoma.     

Biomechanics of echothiophate-induced anatomic changes in monkey aqueous outflow system

Cynomolgus monkeys underwent long-term topical treatment with echothiophate, echothiophate + atropine, or control solution. Echothiophate-treated eyes exhibited increased intraocular pressure, collapse and densification of the trabecular meshwork with accumulation of extracellular material in the cribriform region, alterations in the shape and orientation of Schlemm's canal and the ciliary muscle, and discontinuity between ciliary muscle bundles and trabecular beams. Atropine or ciliary muscle disinsertion with subsequent scar formation supporting the mesh posteriorly at least partially prevented these alterations. Only sometimes did discontinuing echothiophate treatment restore normal anatomy. Collectively, these findings indicate that the pathophysiology of structural alterations in the outflow apparatus induced by echothiophate (1) is mediated at least in part by an anterior segment muscarinic receptor, (2) involves mechanical factors and underperfusion of the meshwork, and (3) does not involve any direct toxic effect of echothiophate.Supported by grant no. 124/2-2 from the Deutsche Forschungsgemeinschaft and by grants EY00137, EY02698 and TW01044 from the National Institutes of Health     

体外培养猴眼小梁细胞及睫状肌细胞中组织金属蛋白酶抑制剂的表达

目的：观察体外培养的正常猴眼小梁细胞及睫状肌细胞中组织金属蛋白酶抑制剂（tissue inhibitors of metalloproteinase,TIMP)的表达,探讨生理状态下基质金属蛋白酶（matrix metalloproteinase,MMP)及TIMP在小梁网房水流出及葡萄膜－巩膜房水流出的通道中的作用。方法：采用Reverse-zymography技术,检测猴眼小梁细胞及睫状肌细胞中TIMP及MMP的表达。结果;猴眼小梁细胞及睫状肌细胞培养液中均可见TMIP－1、TIMP－2及TIMP－3表达,小梁细胞中MMP／TIMP比值明显高于睫状肌细胞。结论：正常状态下小梁细胞外基质的降解能力明显高于睫状肌细胞,可能是由于传统的小梁网房水流出通道作用强于葡萄膜－巩膜房水流出通道 的作用。