Ultrastructural changes of the anterior chamber angle structures in patients with secondary glaucoma after complicated destructive keratitis.

Abstract

Introduction: Secondary glaucoma ( SG) in patients with severe destructive keratitis is a serious, widespread complication with a frequency of up to 19.5% of cases, which significantly worsens the postoperative prognosis of curative keratoplasty. Aim: To study ultrastructural changes of anterior chamber angle structures in patients with secondary glaucoma after complicated destructive keratitis. Methods: Ultrastructural changes of anterior chamber angle structures in patients with SG due to complicated destructive keratitis in 4 patients (8 objects) were studied. Antiglaucoma surgery was performed 3, 6, 17 and 18 months after the acute phase of the infectious inflammatory process (abscess, corneal ulcer), while conservative hypotensive therapy was not effective. During antiglaucoma surgery (deep sclerectomy with autosclerodrainage and basal iridectomy), material was taken for electron microscopic examination. The material was fixed in 2.5% solution of glutaraldehyde on phosphate buff er (pH 7.4), additional fixation with 1% solution of osmium acid and buff er solution (pH 7.4). Contrasting ultrathin sections was performed by the Reynolds method. Tissue samples were studied and photographed in an electron microscope PEM-100-01. Results: In patients with SG, which developed as a result of severe infectious inflammatory process of the cornea, destructive and degenerative changes of the trabecular area, sclera and iris were ultrastructurally detected. Degenerative changes in collagen fibrils and endothelial cells of trabecular and percanalicular tissues up to complete atrophy of the trabeculae were revealed. There were signs of damage of the architectonics, rotting of collagen fibrils, edema of the ground substance of the connective tissue, mucosal swelling and fi brinoid destruction of scleral fibers. Hydropic epithelial cell dystrophy with organelle degeneration of the iris. The presence of active lymphocytes in the stroma of the iris indicates the presence of productive inflammation process. Conclusions: Intense destructive and degenerative damage of the anterior chamber angle structures in patients with SG developed as a result of severe infectious inflammatory destructive lesions of the anterior eye were revealed. The obtained data of ultrastructural changes, the lack of effectiveness of conservative antihypertensive therapy indicate that surgical treatment is the method of choice in the secondary glaucoma treatment in patients with severe destructive keratitis.