physiology of aqueous humor
DESCRIPTION
Physiology of aqueous humorTRANSCRIPT
PHYSIOLOGY OF AQUEOUS HUMORDR GAN
AQUEOUS HUMOR
Clear, colorless fluid that fills anterior and posterior chambers
PHYSIOLOGICAL PROPERTIES
Volume 0.31ml Refractive index 1.333 PH 7.2 Hyperosmotic Rate of formation 1.5 – 4.5ul/min
COMPOSITION
Water constitutes 99.9% of normal aqueous Protein (5-16mg/100ml) concentration in aqueous is
less than 1% of plasma concentration Glucose 75% of plasma concentration Electrolyte:
Na+: similar in plasma and aqueous Bicarbonate ion: concentration higher in PC & lower in AC Cl ion concentration higher than plasma and phosphate
concentration lower than plasma Ascorbic acid concentration very high in aqueous Various components of coagulation and anticoagulation
pathways may be present in human aqueous humor
FUNCTIONS OF AH
Brings oxygen and nutrients to cells of lens, cornea, iris
Removes product of metabolism and toxic substances from those structures
Provides optically clear medium for vision Inflates globe and provides mechanism for
maintaining IOP High ascorbate levels protect against UV-induced
oxidative products, eg: free radicals Facilitates cellular and humoral responses of eye
to inflammation and infection
THE BLOOD-AQUEOUS BARRIER
Barriers to movement of substances from the plasma to AH
In the ciliary body the barriers include Vascular endothelium Stroma Basement membrane Pigmented and non-pigmented epithelium
The blood-aqueous barrier is responsible for differences in chemical composition between plasma and aqueous humor
Breakdown of blood aqueous barrier In some situations (eg intraocular infection), a
breakdown of blood-aqueous barrier is clearly therapeutic
In other situations (eg some forms of uveitis and following trauma), the breakdown of barriers leads to complication
AQUEOUS HUMOR DYNAMICS
Secreted by ciliary epithelium lining ciliary processes Enters the posterior chamber It then flows around the lens and through the pupil into AC There is convention flow of aqueous in the AC due to
temperature gradiant It leaves the eye by two pathways at the anterior chamber
angle: Through the TM, across inner wall of Schlemm’s canal into its
lumen, and thence into collector channels, aqueous veins, and the episcleral venous circulation – trabecular or conventional route
Across the iris root, uveal meshwork, and the anterior face of ciliary muscle, through the connective tissues between the muscle bundles, the suprachoroidal space, and out through the sclera – uveoscleral or unconventional route
AQUEOUS HUMOR PRODUCTION
Produced from pars plicata along the crests of the ciliary processes.
Derived from plasma within capillary network of ciliary processes
3 physiologic processes contribute to the formation and chemical composition of the AH: Diffusion Ultrafiltration Active secretion
DIFFUSION
Movement of substance across a membrane along concentration gradient
As AH passes from PC to Schlemm’s canal, it is in contact with ciliary body, iris, lens, vitreous, cornea, and trabecular meshwork
There is diffusional exchange, so that AC AH resembles plasma.
ULTRAFILTRATION
The process by which fluid and its solutes cross semipermeable membrane under pressure gradient is called ultrafiltration
As blood passes through capillaries of ciliary processes, about 4% of plasma filters through capillary wall into the interstitial spaces between capillaries and ciliary epithelium
In the ciliary body, fluid movement is favored by the hydrostatic pressure difference between capillary pressure and the interstitial fluid pressure and is resisted by the difference between the oncotic pressure of the plasma and the aqueous humor
ACTIVE TRANSPORT
Energy-dependent process that selectively moves substance against its electrochemical gradient across a cell membrane
It is postulated that majority of AH formation depends on active transport
It is done by non-pigmented epithelial cells
BASIC PHYSIOLOGIC PROCESSES
Accumulation of plasma reservoir Most plasma substances pass easily from
capillaries of ciliary processes, across stroma, and between pigmented epithelial cells before accumulating behind the tight junctions of the nonpigmented epithelium
This movement takes place primarily by diffusion and ultrafiltration
TRANSPORT ACROSS BLOOD-AQUEOUS BARRIER
Active secretion is major contributor to AH formation
Selective transcellular movement of certain cations, anions, and other substances across the blood-aqueous barrier formed by the tight junctions between the nonpigmented epithelium
Aqueous humor secretion is mediated by transferring NaCl from ciliary body stroma to PC with water passively following.
Carbonic anhydrase mediates transport of bicarbonate across the ciliary epithelium through a rapid interconversion between HC)3 and CO2
Other transported substances include ascorbic acid, which is secreted against a large concentration gradient by the sodium-dependent vitamin C transporter 2
Osmotic Flow The osmotic gradient across ciliary epithelium,
results from active transport It favors the movement of other plasma
constituents by ultrafiltration and diffusion
BIOCHEMISTRY OF AQUEOUS HUMOR FORMATION
The structural basis for aqueous humor secretion is the bilayered ciliary epithelium (pigmented & nonpigmented epithelium)
The active process of aqueous secretion is mediated by 2 enzymes present in the NPE: Na-K-ATPase and carbonic anhydrase
AQUEOUS HUMOR OUTFLOW
AH leaves the eye at AC angle through TM, Schlemm’s canal, intrascleral channels, and episcleral and conjunctival veins
Referred as conventional/trabecular outflow In unconventional or uveoscleral outflow, AH
exits through root of iris, between ciliary muscle bundles, then through the suprachoroidal-scleral tissues
Trabecular outflow accounts for 70-95% of aqueous outflow
And remaining 5-30% by uveoscleral outflow
CELLULAR ORGANIZATION OF TRABECULAR OUTFLOW PATHWAY
Scleral spur- the posterior wall of scleral sulcus formed by a group of fibers, the scleral roll, which run parallel to the limbus and project inward to form scleral spur
Schwalbe line- anterior to the apical portion of the trabecular meshwork is a smooth area calledas zone S. The posterior borders is demarcated by a discontinuous elevation, called the Schwalbe line
Trabecular meshwork- the scleral sulcus is converted into a circular channel, called Schlemm’s canal, by the trabecular meshwork. It may be divided into 3 portion: (a) uveal meshwork; (b) corneoscleral meshwork; (c) juxtacanalicular tissue
Uveal Meshwork This innermost portion is adjacent to AH in AC and is arranged in ropelike trabeculae that extend from iris root and ciliary body to peripheral cornea
Corneoscleral Meshwork This portion extends from the scleral spur to the anterior wall of the scleral sulcus
Juxtacanalicular Tissue This structure has 3 layers. The inner trabecular endothelial layer is continuous with the endothelium of corneoscleral meshwork. The central connective tissue layer & outermost portion is the inner wall endothelium of the Schlemm canal
Episcleral and Conjunctival Veins The Schlemm canal is connected to episcleral and conjunctival veins by a complex system of intrascleral channels
2 systems of intrascleral channels have been identified: Direct system of large caliber vessels, with short
intrascleral course, drain into episcleral venous system Indirect system of more numerous, finer channels,
which form an intrascleral plexus before draining into episcleral venous system
PUMPING MODEL FOR TRABECULAR OUTFLOW
The aqueous outflow pump receives power from the transient increases in IOP such as occur in systole of the cardiac cycle, during blinking and during eye movement.
CELLULAR ORGANIZATION OF THE UVEOSCLERAL PATHWAY
2 unconventional pathways have been discriminated: (a) through anterior uvea at the iris root, uveoscleral pathway, and (b) through transfer of fluid into the iris vessels and vortex veins, which has been described as uveovortex outflow
The uveoscleral pathway is characterized as “pressure independent”
It is reduced by cholinergic aganists, aging, and is enhanced by prostaglandin drugs.
A potential explanation for the observed decline in uveoscleral outflow with the aging is thickening of elastic fibers in the ciliary muscles.
FACTORS EXERTING LONG-TERM INFLUENCE ON IOP
Genetics Age Gender Refractive error Ethnicity
FACTORS EXERTING SHORT-TERM INFLUENCE ON IOP
DIURNAL POSTURAL VARIATION EXERTIONAL INFLUENCE LID AND EYE MOVEMENT INTRAOCULAR CONDITION SYSTEMIC CONDITION ENVIRONMENT GA FOODS AND DRUGS
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