The trabecular meshwork: Structure, function and clinical implications. A review of the literature - 18/08/20

Doi : 10.1016/j.jfo.2020.05.002

J. Buffault ^a,⁎ , A. Labbé ^a,^b,^c,^d, P. Hamard ^a, F. Brignole-Baudouin ^d,^e, C. Baudouin ^a,^b,^c,^d
^a Ophthalmology Department, Centre Hospitalier National d’Ophtalmologie des Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012 Paris, France
^b Ophthalmology Department, hôpital Ambroise-Paré, IHU FOReSIGHT, AP–HP, 9, avenue Charles-De-Gaulle, 92100 Boulogne-Billancourt, France
^c Université de Versailles Saint-Quentin-en-Yvelines, 78000 Versailles, France
^d Inserm, CNRS, Institut de la Vision, Sorbonne University, 17, rue Moreau, 75012 Paris, France
^e Laboratory Department, Centre Hospitalier National d’Ophtalmologie des Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012 Paris, France

^⁎Corresponding author.

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Summary

Glaucoma is a blinding optic neuropathy, the main risk factor for which is increased intraocular pressure (IOP). The trabecular meshwork, located within the iridocorneal angle, is the main pathway for drainage of aqueous humor (AH) out of the eye, and its dysfunction is responsible for the IOP elevation. The trabecular meshwork is a complex, fenestrated, three-dimensional structure composed of trabecular meshwork cells (TMC) interdigitated into a multilayered organization within the extracellular matrix (ECM). The purpose of this literature review is to provide an overview of current understanding of the trabecular meshwork and its pathophysiology in glaucoma. Thus, we will present the main anatomical and cellular bases for the regulation of aqueous humor outflow resistance, the pathophysiological mechanisms involved in trabecular dysfunction in the various types of glaucoma, as well as current and future therapeutic strategies targeting the trabecular meshwork.

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Keywords : Trabecular meshwork, Glaucoma, Intraocular pressure, Ocular hypertension, Iridocorneal angle, Trabecular meshwork cells, Aqueous humor, Primary open angle glaucoma, Secondary glaucoma, Steroid-induced glaucoma, Pigmentary glaucoma, Pseudoexfoliative glaucoma, Glaucoma medications, Trabeculoplasty, Glaucoma surgery