ophthalmic pathology laboratories process trabeculectomy specimens
routinely. There is roughly up to a 10% incidence of unexpected findings
(subclinical iris neovascularization, inflammation, or neoplasm) in
if scleral spur is identified in the trabeculectomy block, then the
surgeon has disinserted the ciliary body from its insertion, creating
a cyclodialysis in addition to removing a trabeculectomy block. Discovery
of scleral spur tissue in the trabeculectomy block may therefore be
helpful in understanding persistent and profound postoperative hypotony.
iris tissue is quite fragile. It may be placed on a flat mount (such
as filter paper). It is probably best to avoid placing flimsy iris
tissue on surgical sponges which may expand when contacting the fixative,
thereby tearing the tissue sample.
trabeculectomy blocks and iris fragments may be quite small. During
the grossing procedure, the prosector may wish to place a droplet
of eosin on the samples to permit the histology technicians to identify
the tissue when it is taken from the tissue processor for embedding.
should comment on the presence or absence of:
spur tissue in the trabeculectomy block
exfoliation material, neoplasm, or neovascularization in the iris
neovascular membrane (arrows) lines the surface of the iris. This
finding was subclinical and
unsuspected before surgery.
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