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概要

Pathological Study of Secondary Glaucoma due to Congenital Syphilis-A New Theory of Vasculitis in the Schlemm's Canal

Seiichiro Hayashi, Teruhiko Hamanaka and Tamiko Takemura

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.