what is really going on in glaucoma? 25 years of experience · case study 34 hour glaucoma...
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What is Really Going on in Glaucoma?25 years of experience
Richard R Dubielzig
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Canine Primary Glaucoma
• Goniodysgenesis• Pectinate ligament dysplasia• Mesodermal dysgenesis• Open-angle, closed-cleft glaucoma (Peiffer)• Acute angle-closure glaucoma (Miller)• Who knows what else
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Primary Glaucoma in Dogs• 28% of Cocker Spaniels in the COPLOW
collection are affected• 35% of Bassett Hounds • 62% Female
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The Normal Canine Angle
Dr Kerry Ketring
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The Normal Canine Angle
Primary Pectinate Ligament
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The Normal Canine Angle
Ciliary Cleft
Corneoscleral TrabecularMeshwork
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GoniodysgenesisNormal Pressure
Dr Kerry Ketring
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What is Canine Primary Glaucoma?• Sudden onset of painful, red, often blind eye with very
high pressures– In this study the time of disease is measured from when the
owner first notices a painful red eye (Hour 0)• The response to treatment is variable, but severe cases
are blind from the start
• Enucleation is a common outcome – When dealing with the second eye, enucleation is often
chosen very early (24 hours from the first signs of disease)
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Pigment Dispersionand
Neutrophilic Inflammation
Chris Reilly
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Pigment Dispersion in Primary Glaucoma
• Distinguish superior from inferior angle by pigment alone– 1 to 3 Days: 92%– 4 to 7 Days: 95%– Chronic: 79%
• Cells Stripped from Iris– 1 to 3 Days: 43%– 4 to 7 Days: 75%– Chronic: 55%
• Pigmented Cells in the Angle– 1 to 3 Days: 64%– 4 to 7 Days: 95%– Chronic: 50%
Reilly CM et al. (2005) Canine goniodysgenesis-related glaucoma: a morphologic reviewof 100 cases looking atinflammation and pigment
dispersion. Vet. Ophthal.
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Neutrophilic Inflammation
• 1 to 3 Days: 86%• 4 to 7 Days: 50%• Chronic: 15%
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Upper Angle
Lower Angle
Pigment Dispersion
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30 hour Glaucoma
Early Changes in the Iridocorneal Angle
Neutrophils and Spindle Cell Proliferation
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One Day Trabecular Meshwork
Evidence of Gradual Atrophy of the Corneoscleral Trabecular Meshwork
Normal Atrophic
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Pre-Glaucoma: The Second Eye
The Up Side The Down Side
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The Second EyeAtrophy of the trabecular meshwork
Up Down
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Case Study 34 hour glaucoma
5 year-old spayed Laborador
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Case Study 34 hour glaucoma
5 year-old spayed Laborador
Radiating bands of retinalnecrosis
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Case Study 34 hour glaucoma
Goniodysgenesis
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Case Study 34 hour glaucoma
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Case Study 34 hour glaucoma
“Red-Dead” Ganglion Cells
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Effects of Primary Glaucoma on the Optic Nerve and the Retina
Two Day Glaucoma, Canine 24 Hour Glaucoma, Canine
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30 hour Glaucoma
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Optic Nerve 2 to 4 Days
Necrosis of the neuropil
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Three day Glaucoma
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4 Day Optic Nerve HeadPhagocytosis/Malacia
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Five day Canine Glaucoma
Stained for phagocytes
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5 day Canine Glaucoma
Gitter cell macrophages
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By seven days the opticnerve head is end-stagewith deep cupping andgliosis
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Schnabel's cavernous optic atrophy
Entrappedvitreous
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Early Progression of Retinal Disease
Kerry Ketring images
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2 to 4 Day Glaucoma (Canine)
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2 to 4 Day Glaucoma (Canine)
Sampled forHistopathology
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Four Day Glaucoma
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One Day GlaucomaRed-Dead Ganglion Cells
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Proptosis, 3 days
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Electronmicrograph of 4-Day GlaucomaApoptosis
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BuphthalmosScleral Thickness
NormalCanine
4 DayGlaucoma
7 Day Glaucoma
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BuphthalmosScleral Thickness
NormalCanine
4 DayGlaucoma
7 Day Glaucoma
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Average Ganglion Cell CountsThis count includes “Red Dead” cells
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“Red Dead” Ganglion Cells
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Average Retinal Thickness, μ
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Average Scleral Thickness, μ
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Phagocytes in the Retina and Optic Nerve
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Retinal MHC-2 Phagocytes
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Optic Nerve MHC-2 Phagocytes
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MHC-2 on 4-5 Day Glaucoma Optic Nerve
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Retinal GFAP
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Suggested TimelineBefore the Owner Detects Pain
1. Young normotensive dog with goniodysgenesisa) Ciliary cleft open at first
2. Gradual loss of ganglion cellsa) Likely bouts of pressure spikesb) Pigment dispersion?
3. Gradual atrophy of the corneoscleral trabecular meshwork4. Collapse of the ciliary cleft
a) Detected with ultrasound biomicroscopy
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Suggested TimelineAfter the Owner Detects Pain
1. Sudden painful crisisa) Pathology suggests an event 2-3 days before owner
detects2. Stepwise rapid necrosis of the optic nerve and retina
a) Neutrophils, dead ganglion cells, apoptosis, and finally phagocytosis
3. The second eye progresses through the same cycle