[Indications for the location of trabeculotomy in simple glaucoma. II. The demonstration of aqueous outflow with fluorescein]

Abstract

Iontophoresis is less apt to prove the existence of outflow channels of aqueous humour, but it is appropriate in demonstrating filtering blebs. After injecting fluorescein directly into the anterior chamber, the outflow channels are clearly marked in enucleated non-glaucomatous eyes, as well as in eyes containing a tumor, prior to enucleation. Regularly, one is able to observe sectors in which the aqueous veins are filled slowly or not filled at all. Injecting fluorescein directly in Schlemm's canal proves that in cadaver eyes without glaucoma the lumen is open all around. Sectorial filling defects of vessels leading out of Schlemm's canal are often seen. In three patients with simple glaucoma blocking of dye was noticed during passage through Schlemm's canal without reappearance. Our experiments give the impression that segmental division of Schlemm's canal is more marked in eyes with glaucoma than in normal eyes. If local occlusions within Schlemm's canal are of importance for the range of lowering of intraocular pressure, one must differentiate between the trabecular and the intrascleral part of the resistance of outflow in the operation field, in order to choose the best operating procedure. Such a differentiation seems, in principle, possible using fluorescein--primarily injected into the anterior chamber directly, and secondarily into a given part of Schlemm's canal.