-
Proceedings of the National Academy of... Jul 2022The anterior segment of the eye consists of the cornea, iris, ciliary body, crystalline lens, and aqueous humor outflow pathways. Together, these tissues are essential...
The anterior segment of the eye consists of the cornea, iris, ciliary body, crystalline lens, and aqueous humor outflow pathways. Together, these tissues are essential for the proper functioning of the eye. Disorders of vision have been ascribed to defects in all of them; some disorders, including glaucoma and cataract, are among the most prevalent causes of blindness in the world. To characterize the cell types that compose these tissues, we generated an anterior segment cell atlas of the human eye using high-throughput single-nucleus RNA sequencing (snRNAseq). We profiled 195,248 nuclei from nondiseased anterior segment tissues of six human donors, identifying >60 cell types. Many of these cell types were discrete, whereas others, especially in the lens and cornea, formed continua corresponding to known developmental transitions that persist in adulthood. Having profiled each tissue separately, we performed an integrated analysis of the entire anterior segment, revealing that some cell types are unique to a single structure, whereas others are shared across tissues. The integrated cell atlas was then used to investigate cell type-specific expression patterns of more than 900 human ocular disease genes identified through either Mendelian inheritance patterns or genome-wide association studies.
Topics: Adult; Anterior Eye Segment; Aqueous Humor; Atlases as Topic; Ciliary Body; Eye Diseases; Genome-Wide Association Study; Humans; Iris; Organ Specificity
PubMed: 35858321
DOI: 10.1073/pnas.2200914119 -
Middle East African Journal of... 2015In recent years, many new procedures and implants have been introduced as safer alternatives for the surgical treatment of glaucoma. The majority of these advances are... (Review)
Review
In recent years, many new procedures and implants have been introduced as safer alternatives for the surgical treatment of glaucoma. The majority of these advances are implant-based with a goal of increased aqueous drainage to achieve lower intraocular pressure (IOP). In contrast, endoscopic cyclophotocoagulation (ECP) lowers IOP through aqueous suppression. Although ciliary body ablation is a well-established method of aqueous suppression, the novel endoscopic approach presents a significant evolution of this treatment with marked improvement in safety. The endoscope couples a light source, video imaging, and diode laser to achieve direct visualization of the ciliary processes during controlled laser application. The result is an efficient and safe procedure that can achieve a meaningful reduction in IOP and eliminate or reduce glaucoma medication use. From its initial use in refractory glaucoma, the indications for ECP have expanded broadly to include many forms of glaucoma across the spectrum of disease severity. The minimally-invasive nature of ECP allows for easy pairing with phacoemulsification in patients with coexisting cataract. In addition, the procedure avoids implant or device-related complications associated with newer surgical treatments. In this review, we illustrate the differences between ECP and traditional cyclophotocoagulation, then describe the instrumentation, patient selection, and technique for ECP. Finally, we summarize the available clinical evidence regarding the efficacy and safety of this procedure.
Topics: Ciliary Body; Endoscopy; Glaucoma; Humans; Intraocular Pressure; Laser Coagulation; Lasers, Semiconductor; Tonometry, Ocular
PubMed: 25624669
DOI: 10.4103/0974-9233.148344 -
Cellular and Molecular Life Sciences :... Sep 2022The ciliary body critically contributes to the ocular physiology with multiple responsibilities in the production of aqueous humor, vision accommodation and intraocular...
The ciliary body critically contributes to the ocular physiology with multiple responsibilities in the production of aqueous humor, vision accommodation and intraocular immunity. Comparatively little work, however, has revealed the single-cell molecular taxonomy of the human ciliary body required for studying these functionalities. In this study, we report a comprehensive atlas of the cellular and molecular components of human ciliary body as well as their interactions using single-cell RNA sequencing (scRNAseq). Cluster analysis of the transcriptome of 14,563 individual ciliary cells from the eyes of 3 human donors identified 14 distinct cell types, including the ciliary epithelium, smooth muscle, vascular endothelial cell, immune cell and other stromal cell populations. Cell-type discriminative gene markers were also revealed. Unique gene expression patterns essential for ciliary epithelium-mediated aqueous humor inflow and ciliary smooth muscle contractility were identified. Importantly, we discovered the transitional states that probably contribute to the transition of ciliary macrophage into retina microglia and verified no lymphatics in the ciliary body. Moreover, the utilization of CellPhoneDB allowed us to systemically infer cell-cell interactions among diverse ciliary cells including those that potentially participate in the pathogenesis of glaucoma and uveitis. Altogether, these new findings provide insights into the regulation of intraocular pressure, accommodation reflex and immune homeostasis under physiological and pathological conditions.
Topics: Aqueous Humor; Ciliary Body; Glaucoma; Humans; Intraocular Pressure; Transcriptome
PubMed: 36163311
DOI: 10.1007/s00018-022-04559-w -
Indian Journal of Ophthalmology Jun 2023UBM is a high-resolution ultrasound technique which allows non-invasive, in vivo imaging of the anterior segment and iridocorneal angle.
BACKGROUND
UBM is a high-resolution ultrasound technique which allows non-invasive, in vivo imaging of the anterior segment and iridocorneal angle.
PURPOSE
This video is compilation of short video clips and images which gives description on identification of angle closure due to pupillary block, peripheral anterior synechiae, iris bombe, plateau iris, supra ciliary effusion, and malignant glaucoma. It also shows video demonstrating partially and fully patent iridotomy and features of trabeculectomy bleb. Synopsis: This video summarizes importance of UBM application in angle closure glaucoma to understand its pathophysiology by showing the relationship between the peripheral iris, trabecular meshwork and ciliary processes.
HIGHLIGHTS
UBM provides two-dimensional, grayscale images of the angle structures and allows identification of non-pupillary block mechanism in angle closure glaucoma, which can be recorded for qualitative and quantitative analyses.
VIDEO LINK
https://youtu.be/prsmGnR8jYc.
Topics: Humans; Ciliary Body; Eye Abnormalities; Glaucoma; Glaucoma, Angle-Closure; Iris; Iris Diseases; Microscopy, Acoustic; Pupil Disorders
PubMed: 37322722
DOI: 10.4103/IJO.IJO_153_23 -
BMJ Case Reports Nov 2021
Topics: Ciliary Body; Humans; Melanoma; Uveal Neoplasms
PubMed: 34764100
DOI: 10.1136/bcr-2021-246386 -
Translational Vision Science &... Oct 2022This study aimed to develop a fully automated deep learning ciliary body segmentation and assessment approach in three-dimensional ultrasound biomicroscopy (3D-UBM)...
PURPOSE
This study aimed to develop a fully automated deep learning ciliary body segmentation and assessment approach in three-dimensional ultrasound biomicroscopy (3D-UBM) images.
METHODS
Each 3D-UBM eye volume was aligned to the optic axis via multiplanar reformatting. Ciliary muscle and processes were manually annotated, and Deeplab-v3+ models with different loss functions were trained to segment the ciliary body (ciliary muscle and processes) in both en face and radial images.
RESULTS
We trained and tested the models on 4320 radial and 3864 en face images from 12 cadaver eye volumes. Deep learning models trained on radial images with Dice loss achieved the highest mean F1-score (0.89) for ciliary body segmentation. For three-class segmentation (ciliary muscle, processes, and background), radial images with Dice loss achieved the highest mean F1-score (0.75 for the ciliary process and 0.82 for the ciliary muscle). Part of the ciliary muscle (10.9%) was misclassified as the ciliary process and vice versa, which occurred owing to the difficulty in differentiating the ciliary muscle-processes border, even by experts. Deep learning segmentation made further editing by experts at least seven times faster than a fully manual approach. In eight cadaver eyes, the average ciliary muscle, process, and body volumes were 56 ± 9, 43 ± 13, and 99 ± 18 mm3, respectively. The average surface area of the ciliary muscle, process, and body were 346 ± 45, 363 ± 83, and 709 ± 80 mm2, respectively. We performed transscleral cyclophotocoagulation in cadaver eyes to shrink the ciliary processes. Both manual and automated measurements from deep learning segmentation show a decrease in volume, surface area, and 360° cross-sectional area measurements.
CONCLUSIONS
The proposed deep learning segmentation of the ciliary body and 3D measurements showed transscleral cyclophotocoagulation-related changes in the ciliary body.
TRANSLATIONAL RELEVANCE
Automated ciliary body assessment using 3D-UBM has the translational potential for ophthalmic treatment planning and monitoring.
Topics: Cadaver; Ciliary Body; Deep Learning; Humans; Imaging, Three-Dimensional; Microscopy, Acoustic
PubMed: 36180029
DOI: 10.1167/tvst.11.10.3 -
The British Journal of Ophthalmology Jan 1972
Topics: Anterior Chamber; Ciliary Body; Drainage; Follow-Up Studies; Glaucoma; Humans; Methods; Sclera
PubMed: 5058715
DOI: 10.1136/bjo.56.1.37 -
Transactions of the American... 1996Transvitreal endophotocoagulation of the ciliary processes is a little-used option for eyes with refractory glaucoma. No histopathologic studies of animals or humans...
PURPOSE
Transvitreal endophotocoagulation of the ciliary processes is a little-used option for eyes with refractory glaucoma. No histopathologic studies of animals or humans have described its effects. We sought to characterize this cilioablative procedure in an animal model, examine its effects in human eyes histopathologically, and evaluate its clinical safety and efficacy in a large series of patients with long-term follow-up.
METHODS
ANIMAL MODEL: Rabbit eyes were treated with lensectomy, vitrectomy, and transvitreal photocoagulation of the ciliary processes. Eyes were enucleated immediately after surgery and at weekly intervals up to 1 month. Light and electron microscopic evaluation of histopathologic changes was performed. Human Eyes: The pathology laboratory files were searched for cases with a history of endocyclophotocoagulation prior to enucleation, and three eyes were identified. Histopathologic sections were retrieved and examined. Clinical Series: A retrospective clinical review was performed of a single surgeon's experience with endolaser to the ciliary processes, including all cases with adequate data on ocular history, preoperative and postoperative visual acuity, intraocular pressure (IOP), and glaucoma medications, and details of surgery. Only eyes with at least 6 months' follow-up were included.
RESULTS
ANIMAL MODEL: Histopathologic examination of rabbit eyes treated with endocyclophotocoagulation demonstrated acute changes of ciliary process destruction, proteinaceous exudate, stromal edema, nuclear pyknosis, and pigment dispersion. Vascular congestion was seen with some hemorrhage. Later, replacement by fibrous or fibrovascular scar developed with loss of the pigmented and nonpigmented ciliary epithelia, absence of ciliary architectural elements, and pigment rounding and clumping. Human Eyes: Histopathologic examination of enucleated human eyes revealed total ablation of the ciliary processes with fibrosis and pigment clumping in areas of treatment. Abrupt transitions between treated and untreated regions could be identified. In some areas fibrocellular membrane proliferation was found extending over the scars that replaced the ciliary processes. Clinical series: Seventy-three patients were identified ranging in age from 2 to 85 years (mean, 57.7), with follow-up of 6 to 130 months (mean, 28.6). Mean number of previous operations was 3.5; mean number of previous glaucoma operations was 1.3. Preoperative mean IOP was 38 mmHg (range, 19 to 75), postoperative mean IOP was 16 mmHg (range, 1 to 50). At 6 months, 58 of 72 eyes (81%) with available IOP data had IOP greater than 5 mmHg and less than 22. At 12 months 48 of 55 (87.3%) were successfully controlled by these criteria, and at last follow-up 50 of 73 (68%). Fifty-six of 73 eyes (77%) were considered clinically stable at the last follow-up in terms of visual acuity, anatomic integrity, and IOP < or = 23 off all glaucoma medications. Visual acuity was stable or improved in 53 of 73 eyes (73%). Complications developed in 9 eyes (12%), including IOP < or = 6 mmHg in 6 eyes (8.2%), peripheral choroidal effusion in 4 (5.5%), fibrinous anterior chamber reaction in 3 (4.1%), phthisis in 2 (2.7%), and choroidal hemorrhage in 1. Thirty-five eyes had penetrating keratoplasty performed before or at the same time as endolaser (an average of 2.14 grafts each), Graft rejection occurred in 4 eyes (11%), and long-term failure of grafts occurred in 11 of 35 (31%). In 31 eyes, additional surgical procedures were performed at the time of endocyclophotocoagulation.
CONCLUSIONS
Endocyclophotocoagulation successfully ablates the ciliary processes, which are replaced with fibrous scar. Surgical results compare favorably with other methods of glaucoma therapy in complicated eyes in terms of IOP control, visual preservation, and complication rate. Endolaser to the ciliary body was especially successful in glaucomatous eyes after keratoplasty, although corneal graft prognosis
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Animals; Child; Child, Preschool; Ciliary Body; Disease Models, Animal; Female; Follow-Up Studies; Glaucoma; Humans; Intraocular Pressure; Keratoplasty, Penetrating; Laser Coagulation; Macaca; Male; Middle Aged; Postoperative Complications; Rabbits; Retrospective Studies; Treatment Outcome; Visual Acuity; Vitreous Body
PubMed: 8981713
DOI: No ID Found -
Experimental Eye Research Dec 2020Transient potential receptor vanilloid 4 (TRPV4) is an ion channel responsible for sensing osmotic and mechanical signals, which in turn regulates calcium signaling... (Review)
Review
Transient potential receptor vanilloid 4 (TRPV4) is an ion channel responsible for sensing osmotic and mechanical signals, which in turn regulates calcium signaling across cell membranes. TRPV4 is widely expressed throughout the body, and plays an important role in normal physiological function, as well as different pathologies, however, its role in the eye is not well known. In the eye, TRPV4 is expressed in various tissues, such as the retina, corneal epithelium, ciliary body, and the lens. In this review, we provide an overview on TRPV4 structure, activation, mutations, and summarize the current knowledge of TRPV4 function and signaling mechanisms in various locations throughout the eye, as well as its role in ocular diseases, such as glaucoma and diabetic retinopathy. Based on the available data, we highlight the therapeutic potential of TRPV4 as well as the shortcomings of current research. Finally, we provide future perspectives on the implications of targeting TRPV4 to treat various ocular pathologies.
Topics: Animals; Cell Membrane; Ciliary Body; Humans; Lens, Crystalline; Osmotic Pressure; Retina; Signal Transduction; TRPV Cation Channels
PubMed: 32979394
DOI: 10.1016/j.exer.2020.108257 -
Current Opinion in Ophthalmology May 2022The complications and inadequate efficacy of prior cyclodestructive procedures limited their role in glaucoma management. Recent advances in treatment techniques and... (Review)
Review
PURPOSE OF REVIEW
The complications and inadequate efficacy of prior cyclodestructive procedures limited their role in glaucoma management. Recent advances in treatment techniques and parameters for laser cyclophotocoagulation has expanded its role in today's glaucoma practice. In this review, we discuss the treatment outcomes of slow-coagulation continuous-wave transscleral cyclophotocoagulation (CW-TSCPC) as a glaucoma surgical procedure for multiple types of glaucoma in lowering intraocular pressure (IOP).
RECENT FINDINGS
Slow-coagulation TSCPC is a relatively new technique for CW-TSCPC that, unlike the 'pop' power titration technique of laser energy delivery, aims to avoid the production of the 'pop' sound that signals explosive inflammatory energy delivery to the ciliary body and nearby tissue. In slow-coagulation TSCPC, laser energy is applied in a fixed and lower amount over a longer duration, compared with the conventional pop technique. This laser energy approach leads to more stable, reliable, titratable, and selective ciliary body ablation for control of IOP, especially relative to the controversial current use of micropulse TSCPC.
SUMMARY
Slow-coagulation CW-TSCPC can be used safely, efficiently, reproducibly, and efficaciously in wide range of glaucoma types including those with no history of incisional surgeries, good visual acuity, and medically refractory glaucomas.
Topics: Ciliary Body; Glaucoma; Humans; Intraocular Pressure; Laser Coagulation; Lasers; Retrospective Studies; Sclera; Treatment Outcome
PubMed: 35200163
DOI: 10.1097/ICU.0000000000000837