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N. Gupta, M. Patel, T. Ly, E. Gümü, M. G. Johnston, D. Armstrong, Y. Yucel; Evidence of a New Uveolymphatic Outflow Pathway in Human and Sheep: Implications for Aqueous Humor Drainage and Glaucoma. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2879.
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To determine whether a lymphatic circulation exists within the human and sheep ciliary body, and if present, its relationship to aqueous humor outflow.
Twelve normal human eyes with no history of ocular disease, atherosclerosis or stroke were obtained from the Eye Bank of Canada. Human eye sections were triple-immunostained with D2-40(Signet), CD34(Abcam) and SMA(Abcam) antibodies for lymphatic vessels, blood vessels and smooth muscle cells respectively. Under general anesthesia, 50 µL fluorescent nanospheres (Invitrogen) were injected intracamerally in 3 sheep, with sacrifice 2 (n=2) and 4 (n=1) hours after the injection. Eyes were cryoprotected, serially sectioned and immunostained for a lymphatic endothelial marker (LYVE-1, Diagnostic Laboratories). Confocal laser microscopy was used to image ciliary body and capture images for 3-D construction (Microbrightfield Inc.).
In normal human eyes, numerous fine D2-40 positive lymphatic channels were observed in circular, radial and longitudinal portions of the ciliary muscle, stroma, and ciliary processes. D2-40 positive lymphatic channels surrounded many blood vessels in the ciliary body. In the normal sheep, numerous channels containing fluorescent nanospheres in the ciliary body were outlined by LVYE-1 immunoreactive lymphatic endothelial cells.
A uveolymphatic pathway is described for the first time in the human and sheep ciliary body. The flow of aqueous humor into these channels indicates a new mechanism by which aqueous humor flows out of the eye, and if altered in glaucoma, is a possible novel therapeutic target.
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