Anterior and posterior parts of human trabecular meshwork

From gonioscopic observations, the trabecular meshwork was tentatively divided into anterior and posterior parts. The anterior part was defined as the zone from the Schwalbe's line to the anterior edge of the Schlemm's canal, and the posterior part was from the anterior edge of the Schlemm's canal to the angle recess. The patients' own blood cells were injected into the anterior chamber of two eyes about to be enucleated due to malignant tumors, and cell distribution in the trabecular meshwork was examined histologically. Blood cells in the posterior part of the trabecular meshwork were numerous, particularly in the area adjacent to the Schlemm's canal and anterior to the ciliary muscle at the angle recess, yet only a few cells were seen in the anterior part. At the angle recess, the blood cells accumulated in the perivascular connective tissue of the major arterial circle of the iris. These observations suggest that the posterior part of the trabecular meshwork is the most important for aqueous humor drainage in the human eye, both with regard to the conventional and unconventional routes, while the anterior part plays a lesser role in the aqueous outflow. It is also suggested that some proportion of the aqueous humor entering the tissues at the angle recess may flow through the perivascular tissue of the major arterial circle of the iris.     

An experimental study on mechanism of intraocular pressure decline after allogeneic transplantation of trabecular meshwork

OBJECTIVE: To study the mechanism of intraocular pressure (IOP) decline after allogeneic transplantation of trabecular meshwork (TM) in primate experimental glaucoma. METHODS: The experimental open-angle glaucoma models were created in 8 rhesus monkey eyes by repeated pangoniophotocoagulation on functional TM using argon laser. After 2, 3, 5 months respectively, avidin-gold or self-erythrocytes, which acted as tracers of the aqueous humor outflow, were perfused into the anterior chamber under normal pressure and volume conditions. 30 minutes later, 2.5% glutaraldehyde was perfused into the anterior chamber under the same conditions. Allograft TMs and photocoagulated area (serving as the control) were observed by light, transmission, scanning electron microscopy and ultrahistochemistry study. RESULTS: The IOP of 5 eyes of 6 experimental eyes became normal. A blood reflux into Schlemm's canal was seen by gonioscopy in 4 eyes. The surface of TMs from graft showed the normal uveal TM cords and intertrabecular spaces. Erythrocytes were found in the intertrabecular spaces and Schlemm's canal. Avidin-gold and vacuolar containing gold were observed in the cells of TM and Schlemm's canal. The TMs of photocoagulated area appeared to be fewer and narrower intertrabecular spaces. The uveal cords of this zone were confused. The content of acid mucopolysaccharides in the grafts was closer to normal than that in the photocoagulated areas. CONCLUSION: TM of allogeneic transplantation not only can survive but also function as an aqueous humor outflow pathway. We consider that this operative procedure can be used for treatment of some cases with glaucoma cautiously.     

Scanning electron microscopy of the trabecular meshwork: understanding the pathogenesis of primary angle closure glaucoma

Purpose:

To study ultrastructural changes of the trabecular meshwork in acute and chronic primary angle closure glaucoma (PACG) and primary open angle glaucoma (POAG) eyes by scanning electron microscopy.

Materials and Methods:

Twenty-one trabecular meshwork surgical specimens from consecutive glaucomatous eyes after a trabeculectomy and five postmortem corneoscleral specimens were fixed immediately in Karnovsky solution. The tissues were washed in 0.1 M phosphate buffer saline, post-fixed in 1% osmium tetraoxide, dehydrated in acetone series (30-100%), dried and mounted.

Results:

Normal trabecular tissue showed well-defined, thin, cylindrical uveal trabecular beams with many large spaces, overlying flatter corneoscleral beams and numerous smaller spaces. In acute PACG eyes, the trabecular meshwork showed grossly swollen, irregular trabecular endothelial cells with intercellular and occasional basal separation with few spaces. Numerous activated macrophages, leucocytes and amorphous debris were present. Chronic PACG eyes had a few, thickened posterior uveal trabecular beams visible. A homogenous deposit covered the anterior uveal trabeculae and spaces. Converging, fan-shaped trabecular beam configuration corresponded to gonioscopic areas of peripheral anterior synechiae. In POAG eyes, anterior uveal trabecular beams were thin and strap-like, while those posteriorly were wide, with a homogenous deposit covering and bridging intertrabecular spaces, especially posteriorly. Underlying corneoscleral trabecular layers and spaces were visualized in some areas.

Conclusions:

In acute PACG a marked edema of the endothelium probably contributes for the acute and marked intraocular pressure (IOP) elevation. Chronically raised IOP in chronic PACG and POAG probably results, at least in part, from decreased aqueous outflow secondary to widening and fusion of adjacent trabecular beams, together with the homogenous deposit enmeshing trabecular beams and spaces.     

Ultrastructural alterations in the aqueous outflow pathway of adult buphthalmic rabbits

The aqueous outflow pathway of adult rabbit eyes with congenital glaucoma (buphthalmos) was examined by light microscopy and by scanning and transmission electron microscopy. The morphology of the buphthalmic rabbit aqueous outflow pathway was markedly abnormal when examined at 6 months, 1 yr, and 2 yr displaying apparent loss and/or compression of the iris pillars, dilation of the intertrabecular spaces, loss of endothelial cell-to-cell association and disorganization of trabecular lamellae, and posterior displacement of the aqueous plexus. In addition, the trabecular meshwork lamellae were observed only adjacent to the sclera and the inner portion of the trabecular meshwork was limited to swirls of collagen with scattered cells. These morphological findings suggest that the disease process in the rabbit principally involves an alteration in the differentiation and maintenance of the structural integrity of the trabecular meshwork. The loss of structural support of the buphthalmic trabecular meshwork may be a factor in the wide variation in intraocular pressure and may allow for compression of the trabecular meshwork against the aqueous plexus.     

Nerve fibers in trabecular meshwork surface

The trabecular meshwork surface in the Japanese monkey eye was observed by scanning electron microscopy. Many varicose nerve fibers were recognized in the anterior surface of the trabecular sheets and in the intertrabecular space facing the anterior chamber. The nerve fibers often branched and thus formed a loose-meshed plexus. These varicose nerve fibers were identified by ultrastructural studies after the pretreatment of one animal with 5-hydroxydopamine as an adrenergic agent. Most nerve fibers terminated as free endings without a constant relationship to the endothelial cells of the trabecular sheets. Although the physiological significance of such nerve fibers is not clear, they probably release a transmitter (noradrenaline) into the aqueous humor and have an influence on the aqueous outflow area.     

Age-related changes in the trabecular meshwork of the normal human eye

Specimens from 17 human eyes, ranging in age from 3 to 80 years, were subjected to morphometric studies using light microscope, transmission electron microscope and scanning electron microscope, in order to clarify the age-related changes in the normal trabecular tissue. Statistical analyses showed that the cellularity in the various regions of the trabecular meshwork significantly declined with age. The spaces corresponding to the aqueous outflow pathway in each region of the meshwork also significantly decreased with age. On the other hand, extracellular materials significantly increased in amount with age in all regions of the trabecular meshwork. However, the decrease in the cellularity and the outflow pathway spaces did not show any statistically significant regional difference. These results suggest that general narrowing of the outflow pathway spaces due to the accumulation of extracellular materials with age is the cause of the increase in aqueous outflow resistance with age, and that each region of the trabecular meshwork is equally responsible for the increased resistance.     

Distinctive distribution of HLA class II presenting and bone marrow derived cells in the anterior segment of human eyes.

Cells of bone marrow origin that normally occupy the stroma of the murine iris and ciliary body have been implicated in the immune phenomenon, anterior chamber associated immune deviation (ACAID). Following injection of antigen into the anterior chamber, cells of this type deliver an ACAID inducing signal into the systemic circulation, presumably through the outflow tract. In an effort to identify such cells in man, anterior chambers of 34 human donor eyes of different age groups were stained immunocytochemically with monoclonal antibodies directed at HLA class II molecules, CD 45 (a molecular marker of bone marrow-derived cells) and macrophage-associated membrane molecules (CD 68, CD 14). Within the outflow tissue, the cells of the filtering trabecular meshwork stained with none of those reagents. However, infrequent single, dispersed, dendritic cells were positively stained in the intertrabecular spaces. More numerous labelled cells were found in the anterior- and posterior-most portions of the non-filtering part of the trabecular meshwork. These cells were continuous with stained cells adjacent to the outer wall of Schlemm's canal and to the collector channels. Numerous labelled cells were seen in the vicinity of the intra- and episcleral vessels, the ciliary meshwork, the stroma of the ciliary muscle and epithelial processes, and the iris stroma. With advancing age, increasing numbers of CD 45+, HLA class II expressing cells appeared to accumulate in the so-called uveoscleral pathway. These results indicate that bone marrow-derived cells with the potential to function of ACAID induction reside within human eyes, and that cells of this type are located not only in the stroma of iris and ciliary body, but within the non-filtering portions of the trabecular meshwork and the uveoscleral pathway. The appearance of rare CD 45+ cells "in transit" in the filtering trabecular meshwork is compatible with the view that cells carrying ACAID-inducing signals to the systemic immune apparatus escape from the eye by this route.     

The appearance of the outflow apparatus of the eye after staining with ruthenium red.

The outflow apparatus from adult baboon and rabbit eyes was stained with the inorganic dye ruthenium red. The ruthenium reaction product coated the surface of the trabecular meshwork cells and the canalicular endothelial cells. Deposits also impregnated the various connective tissue elements within the trabeculae and the extracellular spaces of the endothelial meshwork. A fine fibrillar network could also be identified with ruthenium red and this was present in the trabecular cores and the extracellular spaces of the endothelial meshwork. It was considered that the fibrillar network may represent a matrix of glycosaminoglycans and glycoproteins. The significance of these materials in relation to aqueous outflow was discussed.     

The trabecular meshwork in acute and chronic angle closure glaucoma

PURPOSE: To determine the effect of acute and chronic primary angle closure glaucoma (PACG) on the trabecular meshwork. METHODS: Trabecular specimens of 16 consecutive patients with primary angle closure glaucoma (PACG)--6 acute PACG eyes, and 10 chronic PACG eyes without an acute attack--were studied by light and electron microscopy. RESULTS: Acute PACG: The trabecular meshwork revealed a generalised oedema and an accumulation of pigment in the widened trabecular spaces and Schlemm's canal. Attenuated trabecular endothelial cells appeared to be devoid of subcellular components. Chronic PACG: In chronic PACG eyes the trabecular architecture had lost its regular arrangement, with fewer and narrower trabecular spaces and fusion of the trabecular beams in areas. There were numerous electron-dense bodies in the trabecular tissues, both within the trabecular beams and in the extracellular spaces, which had a banded fibrillar structure. An overall loss of endothelial cells was noted; the remaining cells were crowded together and were polymorphic. Melanin pigment was present both within the stroma and in the endothelial cells. CONCLUSIONS: Pigment accumulation in the trabecular spaces and within the cells and a noninflammatory degeneration appeared to be the primary changes in the trabecular meshwork after acute angle closure glaucoma. In chronic PACG eyes, there was evidence of loss of endothelial cells and reactive repair processes. These changes were present in areas away from visible peripheral anterior synechiae. A gonioscopic evaluation of the extent of peripheral anterior synechiae alone may not reflect the extent of trabecular meshwork damage in acute and chronic PACG. Patients experiencing an acute attack of PACG require a long-term follow up, because the intraocular pressure (IOP) may rise later, due to ongoing changes compromising the outflow facility, or due to the effects of aging in the trabecular meshwork.     

非编码RNA调控小梁网组织在青光眼中作用的研究进展

小梁网是前房水引流的重要通道,呈复杂的三维结构,主要的细胞成分是小梁网细胞,细胞之间有交错成多层的细胞外基质。小梁网结构和功能的改变是导致眼压失常甚至视神经损伤的重要原因。有研究发现,非编码RNA(ncRNA)的异常表达可导致小梁网细胞生存率、收缩性能和细胞外基质结构发生改变,房水流出受阻,眼压失控,是青光眼发生的重要机制。目前,与小梁网相关的ncRNA研究涉及多种ncRNA分子和多种类型青光眼,本文将对微小RNA、长链ncRNA和环状RNA等ncRNA在小梁网组织中的研究进展进行综述。     

色素性青光眼的发病机制

色素性青光眼是一类发病机制相对"单纯"的继发性开角型青光眼,眼压升高的主要原因在于大量色素颗粒沉积于小梁网并导致房水流出阻力增加.色素颗粒除了机械性堵塞小梁网间隙,还可导致吞噬色素颗粒超负荷的小梁细胞死亡、裂解,小梁柱暴露并相互融合,小梁网间隙变窄甚至消失.此外,葡萄膜巩膜途径房水动力学改变,复杂的分子遗传以及免疫机制...     

Effects of alpha-chymotrypsin on the outflow routes for aqueous humor

The anterior chamber was perfused with alpha-chymotrypsin, 50 micrograms ml-1, in mock aqueous humor in cynomolgus monkeys. The enzyme caused a marked rise in outflow facility and had clear effects on the structure of the outflow routes for aqueous humor. The intertrabecular spaces in the iridocorneal chamber angle were wider than normal, the openings in the uveal and corneoscleral meshwork appeared enlarged, there was ballooning of the juxtacanalicular region and the inner wall of Schlemm's canal into the canal and also splitting of the inner wall of the canal. The trabecular cells appeared relaxed with most of the cell processes retracted, some broken. There were discontinuities in the cell membrane and blebs. Parts of the trabecular beams were denuded. Two days after the enzyme treatment the facility was in the normal range, no splits in the inner wall of Schlemm's canal we observed but many of the other changes in structure remained. The number of invaginations in the inner wall of Schlemm's canal was markedly reduced after 2-18 days. A second and third perfusion with alpha-chymotrypsin caused a rise in outflow facility similar to the first. Some morphological changes remained 163 days after enzyme treatment. Pilocarpine a few days after alpha-chymotrypsin treatment caused a marked increase in outflow facility. The results suggest that alpha-chymotrypsin affects the glycoproteins of the cell membrane and as a result causes disorganization of the cytoskeleton, loss of loose adhesions and breaks of cell processes. The rapid recovery of the resistance to outflow was probably due to healing of the splits in the inner wall of Schlemm's canal; a marked reduction in the number of cells with invaginations suggests that in addition there may have been a reduction in the number of transcellular pores in the inner wall of Schlemm's canal.     

Funktionelle Morphologie der Abflusswege des Kammerwassers und ihre Veränderungen beim Offenwinkelglaukom

Aqueous humor exits the eye through the trabecular and uveoscleral outflow pathways. Under normal conditions intraocular pressure is maintained in the trabecular outflow pathways in which aqueous humor passes through the trabecular meshwork into Schlemm’s canal. Intraocular pressure is generated through an outflow resistance in the juxtacanalicular region which consists of juxtacanalicular tissue and the inner wall endothelium of Schlemm’s canal. The resistance of this region is under the influence of two contractile systems, the anterior longitudinal portion of the ciliary muscle and the contractile myofibroblast-like cells in the trabecular outflow pathways. Resistance is lowered through contraction of the ciliary muscle or relaxation of the contractile cells in the trabecular outflow pathways. In primary open angle glaucoma, resistance in the juxtacanalicular region is abnormally high. The cause of the increase is related to an increased activity in transforming growth factor beta and connective tissue growth factor signaling. The cells of the trabecular meshwork outflow pathways are stimulated to form a stronger contractile phenotype involving both an increase in the actin cytoskeleton and the surrounding fibrillar extracellular matrix. As a result there is an increase in cellular tone in the trabecular outflow pathways leading to an increase in rigidity and outflow resistance.     

Ultrastructural changes in the aqueous outflow apparatus of beagles with inherited glaucoma

Spontaneous glaucoma in the beagle was exhibited after 6 months of age by elevated intraocular pressures and open iridocorneal angles followed by secondary changes. In order to appreciate alterations of the aqueous outflow apparatus in dogs with this autosomal recessive disorder, the eyes of beagles with inherited glaucoma at ages 1 day through 34 months were examined by light, scanning and transmission electron microscopy. Developmentally, no notable differences were observed between normal and preglaucomatous outflow channels through 7 months of age. In 12-month-old glaucomatous chamber angles clustered basement membrane-like material was found scattered throughout the outer corneoscleral trabecular meshwork. In this region elastin-like fibers appeared to be more numerous and arranged less regularly than age-matched normal eyes. Occasional trabecular cells within the corneoscleral trabecular meshwork possessed small clusters of serrated, opaque rods within their cytoplasm. In the older glaucomatous dogs these changes were more generalized and extensive throughout the entire corneoscleral trabecular meshwork. In some individual eyes the anterior chamber angles were observed to be narrow both clinically and histologically. These outflow apparatuses were additionally characterized by compressed, less organized trabeculae with a concomitant build-up of extracellular materials. No correlation was found between the shallowness of the iridocorneal angle and increase in intraocular pressure. Primary glaucoma in the beagle during its earlier phases compared more positively to open-angle glaucoma in man than any of the other spontaneous types in animals.     

A quantitative study of the prenatal development of the aqueous outflow system in the human eye

There is a multiplicity of theories on the development and differentiation of the human iridocorneal angle. Many have arisen from the need to explain the pathogenesis of primary infantile (congenital) glaucoma or other related developmental disturbances. The present study, which is the first light and electron microscopical morphometric analysis of human fetal eyes, was designed to determine the nature of the changes in various tissue components during trabecular anlage formation and differentiation (between 12 and 22 weeks of gestation). The results demonstrate that the trabecular anlage doubles in cross-sectional area during this period. However, when circumferential growth is considered there is in fact a threefold increase in anlage volume. Cell density in sections decreases over the 10-week period, as does the number of cells per unit volume. However, employment of stereological analysis together with corrections for volume changes revealed a two to threefold increase in absolute number of cells per eye (2.8 x 10(5) to 7.5 x 10(5)). Relative and absolute volume data on the four major constituents of the trabecular anlage show that extracellular matrix increases in the most significant and predictable fashion (360% in absolute volume), with the increase in intertrabecular spaces being more variable (200%). The findings are discussed in relation to previous theories of trabecular meshwork development.     

Modulation of extracellular matrix turnover in the trabecular meshwork

Intraocular pressure (IOP) is the most critical risk factor for primary open angle glaucoma (POAG). In most cases of POAG, IOP is increased because of an abnormally high aqueous humor outflow resistance in the juxtacanalicular region of the trabecular meshwork. A distinct structural change in the trabecular meshwork of patients with POAG is the increase in fibrillar extracellular matrix in the juxtacanalicular region of the trabecular meshwork. Our knowledge on the molecular factors that govern turnover of the extracellular matrix in the trabecular meshwork has increased considerably in recent years. It has become clear that quality and quantity of the extracellular matrix in the trabecular meshwork are regulated by several signaling molecules that interact with each other to promote its synthesis, degradation, or extracellular modification. Transforming growth factor-β1 and β2 (TGF-β1 and TGF-β2) which derive from the aqueous humor or may be locally expressed induce in cultured trabecular meshwork cells the expression of a variety of extracellular matrix molecules. The action of TGF-βs very likely requires local activation by thrombospondin-1 and is partly mediated by its downstream mediator connective tissue growth factor, both of which are constitutively expressed in the trabecular meshwork. Bone morphogenetic proteins (BMP)-7 and -4 effectively antagonize the effects of TGF-β2 on matrix deposition. The antagonizing effects of BMP-7 are mediated in trabecular meshwork cells through Smad7. Smad7 is a key molecular switch to inhibit TGF-β2 signaling in the trabecular meshwork.     

Open-angle Glaucoma Associated with Posterior Polymorphous Dystrophy: A Clinicopathologic Study

Clinical and histopathologic features of a 62-year-old black man with posterior polymorphous dystrophy and open-angle glaucoma requiring trabeculectomy are reported. The surgical procedure was modified to allow en bloc resection of the deep limbal tissue and peripheral iris. Light and electron microscopy of the specimen revealed a high insertion of the iris into the posterior portion of the trabecular meshwork with compression of the intertrabecular spaces. These findings are similar to changes that have been reported in primary congenital glaucoma and suggest a developmental anomaly of the anterior chamber angle in this form of glaucoma associated with posterior polymorphous dystrophy.     

Histologic findings in pigment dispersion syndrome and pigmentary glaucoma

PURPOSE: To investigate the morphologic changes in the trabecular meshwork in a case series of eyes with pigment dispersion syndrome and pigmentary glaucoma, and surgical trabeculectomy specimens from eyes with pigmentary glaucoma. MATERIALS AND METHODS: Trabecular meshworks from 6 whole eyes from 3 donors and 7 trabeculectomy specimens were studied by light and electron microscopy. Axonal counts from the whole eyes were correlated with qualitative and quantitative data of meshwork changes. RESULTS: Changes in the meshwork varied around the circumference of the eyes, but in all 6 eyes in most regions of the circumference there were numerous pigment granules within trabecular cells; pigment was not found within intertrabecular or cribriform spaces. In some regions of the circumference there was trabecular cell loss, loss of intertrabecular spaces, fusion of lamellae, and an increase in extracellular material under the inner wall of the canal. Separation of the normal tendinous connection to the canal wall cells was noted in some regions of all eyes. This change could be associated with regions of pathologic separation of the inner wall from the cribriform region, associated with partial obliteration of the lumen of the canal with cells and cell processes. In eyes with pronounced axon loss, meshworks showed most pronounced loss of trabecular cells and increased extracellular material. Trabeculectomy specimens had similar changes and, in addition, showed damaged trabecular cells and collapse of intertrabecular spaces without fusion of lamellae, consistent with artifacts from manipulation during surgery. CONCLUSIONS: Loss of trabecular cells, fusion of trabecular lamellae with collapse of intertrabecular spaces, increase in extracellular material, and obliteration of the canal were found in various amounts around the circumference of eyes with pigment dispersion syndrome and elevated intraocular pressure, and pigmentary glaucoma. These probably all contribute to the development of increased intraocular pressure. Meshworks from trabeculectomy specimens showed these findings and also showed artifactual damage of cells and loss of intertrabecular spaces. This suggests that handling during surgery may cause single trabeculectomy specimens to give only an incomplete picture of the pathophysiology of pigmentary glaucoma.     

Perfusion of his-tagged eukaryotic myocilin increases outflow resistance in human anterior segments in the presence of aqueous humor

PURPOSE: A previous study by the authors has shown that recombinant myocilin purified from a prokaryotic expression system increases outflow resistance in cultured human anterior segments. The present study was performed to determine whether full-length myocilin purified from a human trabecular meshwork cell expression system alters outflow resistance after infusion into human anterior segments. METHODS: A feline immunodeficiency virus vector encoding both full-length myocilin (amino acids 1-503 fused to C-terminal V5 and six-histidine epitopes) and puromycin resistance was used to transduce a transformed trabecular meshwork cell line (TM5). Stably expressing cells were selected with puromycin. Recombinant myocilin was purified from the media using nickel ion affinity chromatography. Control purifications were performed on media from parental TM5 cells. Anterior segments of human eyes were placed in organ culture and perfused with either Dulbecco's modified Eagle's medium (DMEM) or DMEM supplemented with 50% porcine aqueous humor. One eye received an anterior chamber exchange with recombinant myocilin (2 microg/mL), whereas the fellow eye received an equal volume of control. Immunohistochemistry was performed with anti-myocilin and anti-V5 antibodies. Native polyacrylamide gel electrophoresis was used to analyze myocilin complex formation in porcine aqueous humor. RESULTS: Recombinant myocilin in porcine aqueous humor increased outflow resistance in cultured human anterior segments (91% +/- 68% [mean +/- SD] versus 18% +/- 31% in fellow control eye; n = 9, P = 0.004). Maximum outflow resistance was obtained 5 to 17 hours after infusion and remained above baseline for >3 days. Recombinant myocilin also increased outflow resistance in eyes incubated in DMEM, but only if myocilin was preincubated with porcine aqueous humor (78% +/- 77% when preincubated in DMEM containing porcine aqueous humor versus 13% +/- 15% when preincubated with DMEM alone, n = 6, P = 0.03). Recombinant myocilin appears to form a complex in porcine aqueous humor with a heat-labile protein(s). Immunohistochemistry revealed the presence of myocilin in the juxtacanalicular region of the trabecular meshwork. CONCLUSIONS: Myocilin purified from human trabecular meshwork cells increased outflow resistance in cultured human anterior segments, but only after incubation with porcine aqueous humor. Recombinant myocilin appears to form a complex in porcine aqueous humor that enables it to bind specifically within the trabecular meshwork.     

Clinical,structural and molecular phototherapy effects of laser irradiation on the trabecular meshwork of human glaucomatous eyes

The effects of argon laser trabeculoplasty (LTP) on intraocular pressure (IOP), outflow facility, the morphology of the trabecular meshwork (TM), and the pattern of extracellular glycoprotein fibronectin in trabeculum were studied in 46 eyes of patients with primary open-angle glaucoma (POAG). The LTP was done with informed consent, anticipating that trabeculectomy would be carried out at a scheduled time (2 h to several months following laser therapy). We found that the magnitude of IOP reduction and the improvement in the facility of outflow achieved are directly dependent on the time course after LTP and laser-induced structural changes in trabecular tissue. Light microscopic and immunohistochemical evaluations of the TM specimens at earlier intervals after LTP revealed evidence of heat effects, with disruption and shrinkage of the TM collagenous components and accumulation of fibronectin deposits in the aqueous drainage channels as compared with the TMs of matched patients with POAG who did not receive laser treatment. Within 24 h after LTP, proteins of glaucomatous TMs excised from patients incorporated increased amounts of [³H]-leucine radioactive label; however, the amount of [³H]-leucine-labeled material was significantly depressed in later periods of evaluation. The specimens obtained at longer intervals after LTP showed partial or total occlusion of the intertrabecular spaces by extracellular debris; however, the amount of trabecular fibronectin was not significantly different from that measured 24 h after LTP. At least two potential mechanisms are proposed for the TM tissue response to laser treatment, including heat-induced stretching of the collagen in lamellae and fibronectin-mediated attachment of beams supporting an adhesive tightening of the trabecular components caused by LTP. The changes in laser-induced tissue responses appear to be the result of morphological repair of irradiation-injured trabecular tissue.