Aqueous Angiography-Mediated Guidance of Trabecular Bypass Improves Angiographic Outflow in Human Enucleated Eyes

Invest Ophthalmol Vis Sci. 2016 Sep 1;57(11):4558-65. doi: 10.1167/iovs.16-19644.

Abstract

Purpose: To assess the ability of trabecular micro-bypass stents to improve aqueous humor outflow (AHO) in regions initially devoid of AHO as assessed by aqueous angiography.

Methods: Enucleated human eyes (14 total from 7 males and 3 females [ages 52-84]) were obtained from an eye bank within 48 hours of death. Eyes were oriented by inferior oblique insertion, and aqueous angiography was performed with indocyanine green (ICG; 0.4%) or fluorescein (2.5%) at 10 mm Hg. With an angiographer, infrared and fluorescent images were acquired. Concurrent anterior segment optical coherence tomography (OCT) was performed, and fixable fluorescent dextrans were introduced into the eye for histologic analysis of angiographically positive and negative areas. Experimentally, some eyes (n = 11) first received ICG aqueous angiography to determine angiographic patterns. These eyes then underwent trabecular micro-bypass sham or stent placement in regions initially devoid of angiographic signal. This was followed by fluorescein aqueous angiography to query the effects.

Results: Aqueous angiography in human eyes yielded high-quality images with segmental patterns. Distally, angiographically positive but not negative areas demonstrated intrascleral lumens on OCT images. Aqueous angiography with fluorescent dextrans led to their trapping in AHO pathways. Trabecular bypass but not sham in regions initially devoid of ICG aqueous angiography led to increased aqueous angiography as assessed by fluorescein (P = 0.043).

Conclusions: Using sequential aqueous angiography in an enucleated human eye model system, regions initially without angiographic flow or signal could be recruited for AHO using a trabecular bypass stent.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aqueous Humor / diagnostic imaging
  • Aqueous Humor / metabolism*
  • Cadaver
  • Coloring Agents / pharmacokinetics
  • Eye Enucleation
  • Female
  • Fluorescein Angiography / methods*
  • Fundus Oculi
  • Glaucoma / diagnosis
  • Glaucoma / metabolism
  • Glaucoma / surgery
  • Humans
  • Indocyanine Green / pharmacokinetics*
  • Male
  • Middle Aged
  • Stents
  • Tomography, Optical Coherence
  • Trabecular Meshwork / diagnostic imaging*
  • Trabecular Meshwork / metabolism
  • Trabecular Meshwork / surgery
  • Video Recording

Substances

  • Coloring Agents
  • Indocyanine Green