Anatomy of anterior chamber angle and physiology of aqueous formation & secretion

By: Dr Anumeha

ANATOMY OF ANTERIOR CHAMBER ANGLE

Angle forms the lateral boundary of the ant chamber. It consists specifically of : Schwalbes line Scleral spur Trabecular meshwork and Ciliary muscle bands

A) Schwalbes line:
.Forms peripheral boundary of cornea. .marks the end of normal corneal endothelium..here the ant chamber angle begins with the initial beams of the trabecular meshwork.

B) Trabecular meshwork is sieve like and consists of: Uveoscleral meshwork: innermost Extends from root of iris to Schwalbe line Has cord like meshes which are relatively large corneoscleral meshwork: larger middle portion extends from schwalbe line to scleral spur here meshes are sheet like and small endothelail meshwork: it is outer part called juxtracanalicular links corneoscleral part with the endothelium of inner wall of schlemm canal

 C) scleral spur: forms the projection of collagen fibers from inner sclera Provides ant insertion of longitudinal ciliary muscle fibers and is origin of corneoscleral meshwork

D) Ciliary body band: represents ant aspect of ciliary muscle into which iris root is inserted.

Anatomy of ant chamber angle: a) uveal meshwork b)corneoscleral

meshwork c)schwalbe line d) schlemm canal e) collector channels f) longitudinal muscles of ciliary body g) scleral spur

Gonioscopic view of ant chamber angle

Aqueous humor regulation consists of

Physiology

.Aqueous formation/secretion
.Aqueous outflow

Aqueous humor formation / secretion

. It begins with the ultra filtration of plasma from the ciliary process capillaries. . The inner surface of ciliary body borders a part of post chamber.it has two parts: Pars plicata and pars plana Pars plicata: IT has ciliary processes which project into post chamber and is lined by pigment epithelium which is cont with pig epithelium of retina and a nonpig epith which is cont with neuroretina Each ciliary process has central arteriole, ending in the capillary network. Plicata is responsible for the formation of aqueous.

The tight junction called as ZONA OCCLUDENS betw the non pigmen epith cells forms the blood aqueous barrier

The non pigmented epith actively secrets the aqueous.

Histologically fenestrated capillaries,a loose connective tissue stroma and a metabolically double layered epithelium forms the basis of aqueous humor formation.

 Ultrafiltration represents an important first step in aqueous humor production by which plasma constituents gain entry into the ciliary process stroma,
The capillaries of the ciliary processes are unusually permeable and the ultrafiltrate is rich in proteins Following ultrafiltration, the next step in aqueous formation is active secretion of ions by the nonpigmented layer of the ciliary epithelium.

 The tight junctions between the nonpigmented ciliary epithelial cells ensure that the accumulation of ions in the intercellular cleft creates a strong osmotic gradient, along which water will flow into the posterior chamber

Na/K ATPase pump(present on the epith) plays imp role in the aqu secrtn.the Na gets actively secreted in post chamber..this causes passive flow of water in post chamber

 Inhibition of ATPase enzymes causes decr in aqueous formation

The presence of tight junctns bet epithel is essential for the formation and maintain of osmotic gradient. Oxy and glucose do not enter aqueous as they are required by lens and cornea

Aqueous humor flow

Avg aqueous flow is approx 2.75 microLit /min In morning it is 3.o microLit /min At night it is 1.2 microlit /min Aqueous flows from post chamber via pupil in to ant chamber. Two ways of aqueous flow: 1) Conventional (canalicular,trabecular) 2) Unconventional (extracanalicular,uveoscleral)

Conventional flow (canalicular,trabecular)

Accounts for 90% of flow Flow is through trabeculum into Schlemm canal into aqueous vein and then drains to episcleral veins

This is pressure sensitive route.inc in pressure will cause inc in the outflow
Out flow can be inc by miotics, trabeculotomy and laser trabeculoplasty

Unconventional way(uveoscleral)
Accounts for 10% of flow Flow is through ciliary body to suprachoroidal space drained by venous circulation in sclera and cornea

a) Conventional way b) Unconventional way c) Through iris(very very less flow occurs)

Diagram showing both conventional and unconventional outflow

Aqueous flow

Special consideration
Blood supply to the ant uvea
Ant uvea consists of iris and ciliary body along with its processes These receive blood from the anastomosis formed bet long ant and post ciliary arteries. Anastomosis is present in the ciliary muscles.

Blood supply is through the three anastomotic circles:

A) Episcleral circle: formed by branches of ant
ciliary art

B) Intramuscular circle: formed by branches of long

post ciliary art and branches from perforating ant iliary arte.

C) Major arteriolar circle: present at the root of

iris, formed by ant extention of intramascular circle.

 Branches from the maj arteriol circle supply arterioles to the iris and to ciliary processes
On entering the processes these form the dilated irregular capillaries..these capillaried are enestrated which forms the basis for the aqueous formation