人眼Schlemm管外壁组织结构及其功能的探讨
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摘要
目的 通过观察人眼Schlemm管外壁与深层巩膜组织结构及细胞外基质分布的不同，阐明Schlemm管外壁在维持Schlemm管腔形态中所起的作用。方法 选择2001年8月至2002年4月在我院行非穿透性小梁切除术的开角型青光眼患者，共11例15只眼，对切除的Schlemm管外壁及深层巩膜(巩膜内1／3部)行HE染色、免疫组织化学及Verhoeff氏弹力纤维染色。结果 1．HE染色显示：深层巩膜中纤维组织束不仅粗大，且大小不均，行走方向大部分与巩膜表面平行，但向各方向相互交叉；Schlemm管外壁厚约10-15μm，管腔面较光滑，有单层内皮细胞被覆，内皮细胞分布稀疏，未见明显基底膜。其外有胶原纤维所组成的结缔组织外膜，胶原纤维束直径细小，较均匀一致，排列与Schlemm管平行而无交叉。2．免疫组化染色结果显示：Schlemm管外壁及深层巩膜中均有Ⅰ、Ⅲ、Ⅴ、Ⅵ型胶原分布，Ⅳ型胶原在深层巩膜中仅见于血管壁，Schlemm管外壁中无Ⅳ型胶原分布。3．Verhoeff氏弹力纤维染色结果显示：深层巩膜中弹性纤维量较少，呈细丝状；Schlemm管外壁中有丰富的弹性纤维，呈斑片状。结论 1．Schlemm管外壁与深层巩膜组织构型的不同，使其具有较强的变形抗力及较好的柔韧性，以维持Schlemm管腔形态。2．在我们观察的标本中，Schlemm管外壁与深层巩膜均有Ⅰ、Ⅲ、Ⅴ、Ⅵ型胶原而无Ⅳ型胶原，其光镜下分布相似，且与正常人眼相比，也未见明显改变，但其超微水平上的对比观察，还有待于进一步研究。3．Schlemm管外壁具有大量的弹性纤维，使其抗张强度不如巩膜，但比巩膜具有更好的顺应性，能够根据眼压的波动表现出相应的回弹能力。
Objective To observe the configuration of the outer wall of Schlemm's canal and the deep scleral tissue comparatively, and to study the function of the outer wall of Schlemm's canal. Methods Hematoxylin and eosin stain(H&E), immunohistochemistry and Verhoeff's elastica stain were used to investigate the outer wall of Schlemm's canal and the deep scleral tissue in 11 open-angle glaucoma patients. Results The size and arrangement of collagen fibrils in the outer walls of Schlemm's canal were different from those in deep sclera tissues. The outer walls of Schlemm's canal and the deep sclera tissues both contained types Ⅰ, Ⅲ, V and VI collagen, but no positive staining of type IV collagen in them. There was a large amount of elastic fibers in the outer walls of Schlemm's canal, while little in the deep sclera tissues. Conclusion (1) The divergence between the two anatomic parts exhibits the difference in tissue properties. The outer wall of Schlemm's canal possesses greater creep-resistant properties and mechanical compliance which are important to prevent Schlemm's canal from collapsing. (2) Types Ⅰ,Ⅲ,Ⅴ,Ⅵ collagen are all present in the outer wall of Schlemm's canal and deep scleral tissue. Types Ⅰ and Ⅲ provide the tissue with tensile and extensile strength. Type V collagen has an anchoring function between basement membranes and the adjacent stromal matrix. There was devoid of stain for type IV collagen in the outer wall of Schlemm's canal and deep scleral tissue . (3) Elastic fibers in the outer wall of Schlemm's canal were abundant and appeared in blotchy pattern. It shows a tendency towards restoration with the fluctuation of intraocular pressure.
Postgraduate: He Chunmei (Ophthalmology) Directed by: Prof. Wang Jinghua
Objective To observe the configuration of the outer wall of Schlemm's canal and the deep scleral tissue comparatively, and to study the function of the outer wall of Schlemm's canal. Methods Hematoxylin and eosin stain(H&E), immunohistochemistry and Verhoeff's elastica stain were used to investigate the outer wall of Schlemm's canal and the deep scleral tissue in 11 open-angle glaucoma patients. Results The size and arrangement of collagen fibrils in the outer walls of Schlemm's canal were different from those in deep sclera tissues. The outer walls of Schlemm's canal and the deep sclera tissues both contained types Ⅰ, Ⅲ, V and VI collagen, but no positive staining of type IV collagen in them. There was a large amount of elastic fibers in the outer walls of Schlemm's canal, while little in the deep sclera tissues. Conclusion (1) The divergence between the two anatomic parts exhibits the difference in tissue properties. The outer wall of Schlemm's canal possesses greater creep-resistant properties and mechanical compliance which are important to prevent Schlemm's canal from collapsing. (2) Types Ⅰ,Ⅲ,Ⅴ,Ⅵ collagen are all present in the outer wall of Schlemm's canal and deep scleral tissue. Types Ⅰ and Ⅲ provide the tissue with tensile and extensile strength. Type V collagen has an anchoring function between basement membranes and the adjacent stromal matrix. There was devoid of stain for type IV collagen in the outer wall of Schlemm's canal and deep scleral tissue . (3) Elastic fibers in the outer wall of Schlemm's canal were abundant and appeared in blotchy pattern. It shows a tendency towards restoration with the fluctuation of intraocular pressure.
Postgraduate: He Chunmei (Ophthalmology) Directed by: Prof. Wang Jinghua
引文
1. Grierson I. What is open-angle glaucoma? Eye, 1987, 1:15
2. Flocks M. The pathology of the trabecular meshwork in primary open-angle glaucoma. Trans Am Acad Ophthalmol Otolaryngol, 1958, 62: 556
3. Johnstone MA. Pressure-dependent changes in configuration of the endothelial tubules of Schlemm's canal. Am J Ophthalmol, 1974, 78: 630-638
4. Bill A. Scanning electron microscopic studies of the canal of Schlemm. Exp Eye Res, 1970, 10: 214-218
5. Hoffman F, Dumitrescu L. Schlemm's canal under the scanning electron microscope. Ophthalmol Res, 1971, 2: 37
6. Hogan MJ, Alvarado JA, Weddell JE. Histology of the human eye: an atlas and textbook, Philadelphia, 1971, WB Saunders
7. Tripathi RC, Tripathi B J: Function anatomy of the anterior chamber angle. In Jakobiec FA, editor: Ocular anatomy, embryology and teratology, Philadelphia, 1982, Harper&Row
8．斯坦珀，主编．贝克—谢弗青光眼诊断与治疗(影印版)．第8版．北京：科学出版社，2001，49
9. Dietlein TS, Luke C, Jacobi PC, et al. Variability of dissection depth in deep sclerectomy: morphological analysis of the deep scleral flap. Graefe's Arch Clin Exp Ophthalmol, 2000, 238: 405-409
10. Robert D. Young. The ultrastructural organization of proteoglycans and collagen in human and rabbit scleral matrix. J. Cell. Sci, 1985, 74: 95-104
11．李凤鸣，主编．眼科全书．第1版．北京：人民卫生出版社，1999，133-134
12. Quigley HA, Dorman-Pease ME, Brown AE. Quantitative study of collagen and elastin of the optic nerve head and sclera in human and experimental monkey glaucoma. Curr Eye Res, 1991, 10: 877-888
13. Parry, D. A. D. and Craig, A. S. Growth and development of collagen fibrils in connective tissue. In: Ruggeri, A. and Motta, P. M., eds. Ultrastructure of the Connective Tissue Matrix. Boston: Martinus Nijhoff, 1984. 34-64
14．张剑．关于“巩膜静脉窦’，这一解剖名词的商榷．中华眼科杂志，1979，15：125-128
15. Montes G. S., Bezerra MSF and Junqueira LCU. () Collagen distribution in tissues. In Ruggeri A and Motta PM eds. Ultrastructure of the Connective Tissue Matrix, Boston: Martinus Nijhoff, 1984. 65-88
16．成军，主编．细胞外基质的分子生物学与临床疾病，第1版．北京：北京医科大
学出版社，1999，15
17． Birk DE, Fitch, JM and Linsenmayer TF. Drganization of collagen types I and V in the embryonic chicken cornea. Invest Ophthalmol Vis Sci, 1986,27: 1470-1477
18． Modesti A, Kalebic T.And Scarpa S. Type V collagen in human amnion is a 12nm fibrillar component of the pericellular interstitium. Eur J Cell Biol, 1984, 35:246-255
19． Bruns RR, Press W, Engvall E, et al. Type VI collagen in extracellular 100nm periodic filaments and fibrils: identification by immunoelectron microscopy. J Cell Biol, 1986,103:393-404
20． Keene DR, Engvall E, Glanville RW. Ultrastructure of type Ⅳcollagen in human skin and cartilage suggests an anchoring function for this filamentous network. J.Cell Biol, 1988, 107:1995-2006
21． Linsenmayer TF, Bruns RR, Mentzer A, et al. Type Ⅳ collagen: immunohistochemical identification as a filamentous compoment of the extracellular matrix of the developing avian corneal stroma. Dev. Biol, 1986,118: 425-431
22． Freeman JL. Comparative biochemistry of type I collagens from human cornea, sclera and skin. In: Hollyfield JG, ed. Proceedings of the Fourth International Symposium on the Structure of the Eye. Netherlands: Elsevier Amsterdam, 1981
23． Keeley FW, Morin JD, Vesely S. Characterization of collagen from normal human sclera. Exp.Eye.Res, 1984, 39: 533-542
24． Andreas Thale, Bernhard Tillmann. The collagen architecture of the sclera-SEM and immunohistochemical studies. Ann Anat, 1993,175:215-220
25． Collin G. Murphy, Andersen J. Yun, David A Newsome, et al. Localization of Extracellular Proteins of the Human Trabecular Meshwork by Indirect Immunofluorescence. American Journal of Ophthalmology, 1987,104: 33-43
26． Marshall GE, Konstas AG, William R.Lee. Collagens in the aged human macular sclera. Curr Eye Res, 1993,12: 143-153
27． Marshall GE, Konstas AG, Lee WR. Immunogold Ultrastructural Localization of Collagens in the Aged Human Outflow System. Ophthalmology, 1991, 98: 692-700
28． Tawara A, Varner HH, Hollyfield JG. Distribution and Characterization of Sulfated Proteoglycans in the Human Trabecular Tissue. Invest Ophthalmol Vis Sci, 1989, 30:2215-2231
29． Hernandez MR, Igoe F, Neufeld AH. Extracellular matrix of the human optic nerve head, Am J Ophthalmol, 1986,102:139-148
30． Hernandez MR. Ultrastructural immunocytochemical analysis of elastin in the human lamina cribrosa. Changes in elastic fibers in primary open-angle glaucoma. Invest Ophthalmol Vis Sci, 1992,33:2891-2903
31． Quigley HA, Brown A, Dorman-Pease ME. Alterations in elastin of the optic nerve head in human and experimental glaucoma, Br J Ophthalmol, 1991,75:552-557
32． Tengroth B, Ammitzboll T. Changes in the content and composition of collagen in the glaucomatous eye-basis for a new hypothesis for the genesis of chronic open angle glaucoma. Acta Ophthalmol, 1984, 62:999-1008
2. Flocks M. The pathology of the trabecular meshwork in primary open-angle glaucoma. Trans Am Acad Ophthalmol Otolaryngol, 1958, 62: 556
3. Johnstone MA. Pressure-dependent changes in configuration of the endothelial tubules of Schlemm's canal. Am J Ophthalmol, 1974, 78: 630-638
4. Bill A. Scanning electron microscopic studies of the canal of Schlemm. Exp Eye Res, 1970, 10: 214-218
5. Hoffman F, Dumitrescu L. Schlemm's canal under the scanning electron microscope. Ophthalmol Res, 1971, 2: 37
6. Hogan MJ, Alvarado JA, Weddell JE. Histology of the human eye: an atlas and textbook, Philadelphia, 1971, WB Saunders
7. Tripathi RC, Tripathi B J: Function anatomy of the anterior chamber angle. In Jakobiec FA, editor: Ocular anatomy, embryology and teratology, Philadelphia, 1982, Harper&Row
8．斯坦珀，主编．贝克—谢弗青光眼诊断与治疗(影印版)．第8版．北京：科学出版社，2001，49
9. Dietlein TS, Luke C, Jacobi PC, et al. Variability of dissection depth in deep sclerectomy: morphological analysis of the deep scleral flap. Graefe's Arch Clin Exp Ophthalmol, 2000, 238: 405-409
10. Robert D. Young. The ultrastructural organization of proteoglycans and collagen in human and rabbit scleral matrix. J. Cell. Sci, 1985, 74: 95-104
11．李凤鸣，主编．眼科全书．第1版．北京：人民卫生出版社，1999，133-134
12. Quigley HA, Dorman-Pease ME, Brown AE. Quantitative study of collagen and elastin of the optic nerve head and sclera in human and experimental monkey glaucoma. Curr Eye Res, 1991, 10: 877-888
13. Parry, D. A. D. and Craig, A. S. Growth and development of collagen fibrils in connective tissue. In: Ruggeri, A. and Motta, P. M., eds. Ultrastructure of the Connective Tissue Matrix. Boston: Martinus Nijhoff, 1984. 34-64
14．张剑．关于“巩膜静脉窦’，这一解剖名词的商榷．中华眼科杂志，1979，15：125-128
15. Montes G. S., Bezerra MSF and Junqueira LCU. () Collagen distribution in tissues. In Ruggeri A and Motta PM eds. Ultrastructure of the Connective Tissue Matrix, Boston: Martinus Nijhoff, 1984. 65-88
16．成军，主编．细胞外基质的分子生物学与临床疾病，第1版．北京：北京医科大
学出版社，1999，15
17． Birk DE, Fitch, JM and Linsenmayer TF. Drganization of collagen types I and V in the embryonic chicken cornea. Invest Ophthalmol Vis Sci, 1986,27: 1470-1477
18． Modesti A, Kalebic T.And Scarpa S. Type V collagen in human amnion is a 12nm fibrillar component of the pericellular interstitium. Eur J Cell Biol, 1984, 35:246-255
19． Bruns RR, Press W, Engvall E, et al. Type VI collagen in extracellular 100nm periodic filaments and fibrils: identification by immunoelectron microscopy. J Cell Biol, 1986,103:393-404
20． Keene DR, Engvall E, Glanville RW. Ultrastructure of type Ⅳcollagen in human skin and cartilage suggests an anchoring function for this filamentous network. J.Cell Biol, 1988, 107:1995-2006
21． Linsenmayer TF, Bruns RR, Mentzer A, et al. Type Ⅳ collagen: immunohistochemical identification as a filamentous compoment of the extracellular matrix of the developing avian corneal stroma. Dev. Biol, 1986,118: 425-431
22． Freeman JL. Comparative biochemistry of type I collagens from human cornea, sclera and skin. In: Hollyfield JG, ed. Proceedings of the Fourth International Symposium on the Structure of the Eye. Netherlands: Elsevier Amsterdam, 1981
23． Keeley FW, Morin JD, Vesely S. Characterization of collagen from normal human sclera. Exp.Eye.Res, 1984, 39: 533-542
24． Andreas Thale, Bernhard Tillmann. The collagen architecture of the sclera-SEM and immunohistochemical studies. Ann Anat, 1993,175:215-220
25． Collin G. Murphy, Andersen J. Yun, David A Newsome, et al. Localization of Extracellular Proteins of the Human Trabecular Meshwork by Indirect Immunofluorescence. American Journal of Ophthalmology, 1987,104: 33-43
26． Marshall GE, Konstas AG, William R.Lee. Collagens in the aged human macular sclera. Curr Eye Res, 1993,12: 143-153
27． Marshall GE, Konstas AG, Lee WR. Immunogold Ultrastructural Localization of Collagens in the Aged Human Outflow System. Ophthalmology, 1991, 98: 692-700
28． Tawara A, Varner HH, Hollyfield JG. Distribution and Characterization of Sulfated Proteoglycans in the Human Trabecular Tissue. Invest Ophthalmol Vis Sci, 1989, 30:2215-2231
29． Hernandez MR, Igoe F, Neufeld AH. Extracellular matrix of the human optic nerve head, Am J Ophthalmol, 1986,102:139-148
30． Hernandez MR. Ultrastructural immunocytochemical analysis of elastin in the human lamina cribrosa. Changes in elastic fibers in primary open-angle glaucoma. Invest Ophthalmol Vis Sci, 1992,33:2891-2903
31． Quigley HA, Brown A, Dorman-Pease ME. Alterations in elastin of the optic nerve head in human and experimental glaucoma, Br J Ophthalmol, 1991,75:552-557
32． Tengroth B, Ammitzboll T. Changes in the content and composition of collagen in the glaucomatous eye-basis for a new hypothesis for the genesis of chronic open angle glaucoma. Acta Ophthalmol, 1984, 62:999-1008
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