June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Structural Confirmation of Lymphatic Outflow from Subconjunctival Blebs in Live Human Subjects
Author Affiliations & Notes
  • Alex S Huang
    Doheny Eye Institute, Los Angeles, California, United States
    Ophthalmology, University of California Los Angeles, Los Angeles, California, United States
  • Sindhu Saraswathy
    Doheny Eye Institute, Los Angeles, California, United States
  • Phillip Le
    Doheny Eye Institute, Los Angeles, California, United States
    Ophthalmology, University of California Los Angeles, Los Angeles, California, United States
  • Gadi Heilweil
    Doheny Eye Institute, Los Angeles, California, United States
    Ophthalmology, University of California Los Angeles, Los Angeles, California, United States
  • Jong Yeon Lee
    Doheny Eye Institute, Los Angeles, California, United States
    Gachon University, Seongnam, Korea (the Republic of)
  • Footnotes
    Commercial Relationships   Alex Huang, Aerie (C), Allergan (C), Glaukos (F), Gore (C), Heidelberg Engineering (F), Qlaris (C), Santen (C); Sindhu Saraswathy, None; Phillip Le, None; Gadi Heilweil, None; Jong Yeon Lee, None
  • Footnotes
    Support  1) NIH Grant EYR01EY030501 [ASH] 2) Glaucoma Research Foundation Shaffer Grant [ASH] 3) Research to Prevent Blindness Unrestricted Grant to UCLA [ASH]
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1771. doi:
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    • Get Citation

      Alex S Huang, Sindhu Saraswathy, Phillip Le, Gadi Heilweil, Jong Yeon Lee; Structural Confirmation of Lymphatic Outflow from Subconjunctival Blebs in Live Human Subjects. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1771.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Subconjunctival blebs are utilized in glaucoma surgeries and in drug delivery with lymphatics hypothesized to drain them. Limited direct evidence for lymphatic outflow is available in live human subjects. The purpose of this study is to perform simultaneous subconjunctival outflow imaging and structural assessment to uncover pathway identity in live human subjects.

Methods : Patients were identified who required intravitreal injections to treat retinal disorders. For anesthesia, they receive subconjunctival lidocaine. Subjects were consented for subconjunctival lidocaine injections (1.98%) that also contained indocyanine green (ICG; 0.005%) (UCLA IRB 20-001064) to perform ocular surface lymphangiography. Subjects were angiographically imaged on their ocular surface (Spectralis; Heidelberg Engineering) to visualize the bleb and ICG-labeled outflow pathways. Simultaneous anterior segment optical coherence tomography (OCT) was performed in cross-section or longitudinal to these pathways.

Results : Fourteen subjects were imaged (M/F=6/8; 77.4±2.6 years [mean±SEM]). Subjects (n=4) who were immediately imaged after tracer injection demonstrated fluorescent blebs but no outflow pathways. All subjects who were imaged after completion of the clinical visit (n=10 subjects; 16±1.6 min after subonjunctival tracer injection) showed visible blebs with 7/10 subjects also demonstrating visible outflow pathways. The pathways appeared sausage-shaped (thicker alternating with thinner regions). OCT in cross-section to these pathways clearly demonstrated superficial subconjunctival lumens. OCT longitudinal to these pathways demonstrated the presence of semi-lunar valves or flaps.

Conclusions : Angiographic imaging of subconjunctival outflow demonstrated sausage-shaped outflow pathways that have been described and that are hypothesized to represent lymphatics. Simultaneous OCT imaging demonstrated valves, a lymphatic hallmark. This study provides multimodal outflow/structural imaging evidence confirming the hypothesis that lymphatics drain blebs in live humans.

This is a 2021 ARVO Annual Meeting abstract.

 


A) ICG ocular surface lymphangiography shows a sausage-shaped bleb-related outflow pathway. B) Placement of OCT B-scan. Region with narrower or lesser OCT signal (white arrow). C) OCT B-scan demonstrates superficial subconjunctival outflow pathway with a semi-lunar valve (black arrow that corresponds to white arrows). White/yellow scale bars = 1mm/0.1mm


A) ICG ocular surface lymphangiography shows a sausage-shaped bleb-related outflow pathway. B) Placement of OCT B-scan. Region with narrower or lesser OCT signal (white arrow). C) OCT B-scan demonstrates superficial subconjunctival outflow pathway with a semi-lunar valve (black arrow that corresponds to white arrows). White/yellow scale bars = 1mm/0.1mm

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