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S. Hayashi, T. Hamanaka, T. Takemura; Pathological Study of Secondary Glaucoma Due to Congenital Syphilis. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4860.
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Secondary glaucoma due to congenital syphilis occurs long after keratitis. Scarring of the limbal area, peripheral anterior synechia (PAS), and trabecular damage may be the reason for impaired aqueous outflow. However, no pathological study has yet been performed. We conducted a pathological study of secondary glaucoma due to congenital syphilis using trabeculectomy specimens.
Ten eyes of 7 patients (a mean age of 67±8.2years range: 55-81 years) were studied. Two eyes of two patients underwent trabeculectomy twice. RPR and TPHA were positive in all patients on blood examination. Stromal opacity of the cornea, thick pigmentation of the trabecular meshwork or PAS, and salt and pepper chorio-retinal atrophy in the periphery of retina were found in all eyes. Trabeculectomy specimens were processed for light microscopy of immunohistochemistry for CD68 and thrombomodulin, and transmission electron microscopy.
The spaces of the trabecular meshwork and Schlemm’s canal were open with a slight infiltration of CD 68-positive cells in 7 trabeculectomy specimens of 7 eyes. In the remaining 5 specimens of 5 eyes, the spaces of the trabecular meshwork and the Schlemm canal were mostly occluded. Inflammatory cells or granuloma were found not only in the trabecular meshwork but along the collector channels. These different morphological changes in outflow routes were also observed between the first and second trabeculectomy specimens.
The morphological difference of occluded and rather normal outflow routes according to the specimens or even those in the same eyes undergoing two trabeculectomies suggested segmental inflammation of the angle. The long-term persistence of segmental vasculitis in the collector channels and the Schlemm canal is strongly suggested to be the reason for angle inflammation.
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