The trabecular meshwork: Structure, function and clinical implications. A review of the literature

Abstract

Glaucoma is a blinding optic neuropathy, the main risk factor for which is increased intraocular pressure (IOP). The trabecular meshwork, located within the iridocorneal angle, is the main pathway for drainage of aqueous humor (AH) out of the eye, and its dysfunction is responsible for the IOP elevation. The trabecular meshwork is a complex, fenestrated, three-dimensional structure composed of trabecular meshwork cells (TMC) interdigitated into a multilayered organization within the extracellular matrix (ECM). The purpose of this literature review is to provide an overview of current understanding of the trabecular meshwork and its pathophysiology in glaucoma. Thus, we will present the main anatomical and cellular bases for the regulation of aqueous humor outflow resistance, the pathophysiological mechanisms involved in trabecular dysfunction in the various types of glaucoma, as well as current and future therapeutic strategies targeting the trabecular meshwork.

Keywords: Aqueous humor; Glaucoma; Glaucoma medications; Glaucoma surgery; Intraocular pressure; Iridocorneal angle; Ocular hypertension; Pigmentary glaucoma; Primary open angle glaucoma; Pseudoexfoliative glaucoma; Secondary glaucoma; Steroid-induced glaucoma; Trabecular meshwork; Trabecular meshwork cells; Trabeculoplasty.