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Abstract
Aims: To investigate histopathological changes in trabeculectomy (TLE) specimens in patients with secondary glaucoma due to congenital syphilis. Methods: Eleven eyes of 8 patients were used. The areas of TLE observed by gonioscopy were photographed before the surgery. Each of 13 TLE specimens (two eyes received TLE twice) were processed for light and transmission electron microscopy. Results: There was no inflammation in the anterior chamber at the time of TLE in any eyes. Gonioscopy showed a mixture of normal, thick pigmentation and peripheral anterior synechia. A variety of histological changes in the angle was observed among the samples or even in the same samples: normal (7 eyes) or occluded (8 eyes) Schlemm’s canal with (7 eyes) or without (4 eyes) inflammatory cells. These various changes were also observed in TLE samples taken from the same angle appearance observed by gonioscopy. Inflammatory cells were restricted to the area around the Schlemm’s canal and collector channels. Conclusion: Persistence of super-long-term inflammation in the angle might be the reason for the late onset of secondary glaucoma due to congenital syphilis. Infiltration of inflammatory cells around the Schlemm’s canal and collector channel despite no inflammation in the anterior chamber strongly suggested vasculitis of the Schlemm’s canal and collector channels. A variety of histological changes in the angle might be primarily caused by segmental inflammation of these vessels.
Highlights
Congenital syphilis is caused by Treponema pallidum infection through the placenta in the embryonic stage and causes ophthalmic symptoms in childhood and adulthood
The patients completed a questionnaire before TLE as to whether they had experienced temporarily decreased vision or whether they had been told by their parents that they had complained of photophobia in childhood
peripheral anterior synechia (PAS) was observed in 7 eyes with a combination of thick pigmentation of the trabecular meshwork (Table 1)
Summary
Clinical features of 11 eyes of 8 patients (2 males and 6 females, mean age: 67 ± 8.2 years, range: 55-81 years) used in this study are listed in table 1. Three different gonioscopic appearances were observed: normal, thick pigmentation over the surface of trabecular meshwork, and peripheral anterior synechia (PAS). Macrophages, CD68-positive cells and lymphocytes (Figure 3c) were found around the Schlemm’s canal at the first and second TLE in both the patients. CRA: Chorio-Retinal Atrophy; GV: Ghost Vessels; OP: Intraocular Pressure; N: Normal appearance; NV: Neovascularization; PAS: Peripheral Anterior Synechia; SO: Stromal Opacity; TLE: Trabeculectomy; TP: Thick Pigmentation over the surface of trabecular meshwork *Angle appearance observed by gonioscopy. IFC: Inflammatory Cells in the angle; TLE: Trabeculectomy; Angle appearanceobserved by gonioscopy in the area of trabeculectomy; TP: Thick Pigmentation on the surface of trabecular meshwork; PAS: Peripheral Anterior Synechia; N: Normal * Location of TLE and angle appearance by gonioscopy The periods between the first and the second TLE in Patients 3 and 6 were 9 months and 14 days, respectively.
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