Supported in part by National Institute of Health contracts R01-EY13178, and P30-EY08098 (Bethesda, MD), the Eye and Ear Foundation (Pittsburgh, PA), and unrestricted grants from Research to Prevent Blindness (New York, NY).

Ethics Statement: Approval was obtained from the Institutional Review Board of the University of Pittsburgh School of Medicine before subject recruitment began. All subjects provided written informed consent before participation in the study.
1. Data Acquisition
<ol>
	<li>Pressure Elevation
	<ol>
		<li>Take baseline measurements (IOP and OCT measurements) by instilling one drop of 0.5% proparacaine into the eye. Wait 3 min for efficacy.</li>
		<li>Gently apply pressure to the temporal sclera with the ophthalmodynamometer, 30 g in cohort 1, and 5 and then 10 g in cohort 2. Then take the desired (IOP and OCT) measurements as follows
		<ol>
			<li>IOP Measurements
			<ol>
				<li>Measure baseline IOP. Elevate pressure as described in section 1.1.</li>
				<li>In cohort 1 instill one drop of 0.5% proparacaine, allow 3 min for efficacy, and apply 30 g of pressure to the sclera. While pressure is being applied, measure IOP using the tonometer following manufacturer&#8217;s instructions.</li>
				<li>In cohort 2, instill one drop of 0.5% proparacaine, allow 3 min for efficacy, and apply 5 g of scleral pressure using a ophthalmodynamometer. Measure IOP during pressure elevation using the tonometer following manufacturer&#8217;s instructions.
				<ol>
					<li>Wait 5 min after the 5 g measurement.</li>
					<li>Apply 10 g of scleral pressure by ophthalmodynamometer, and measure IOP during pressure elevation using the tonometer following manufacturer&#8217;s instructions. Record the IOP and condition (i.e., baseline or 10 g) in the study record.</li>
				</ol>
				</li>
			</ol>
			</li>
			<li>OCT Scanning
			<ol>
				<li>Seat the subject at the OCT scanner. Enter patient demographic data for new subjects, or recall demographic data from the OCT database for previously scanned subjects.</li>
				<li>Select the anterior segment 512 x 128 scan protocol. Center the eye in the video image window. Decrease the distance between the scanner and eye until the cornea cross-sectional image appears in the scan window</li>
				<li>Using verbal commands position the temporal limbus to the center of the scan window by directing patient gaze in the nasal direction</li>
				<li>Acquire the baseline scan, and review the scan for quality. IF acceptable, save, and if not acceptable, repeat this step.
				<ol>
					<li>Accept scans if there are no blinks, and the angle is visualized throughout the volume without drifting off of the edge of the image or flipping at the top.</li>
				</ol>
				</li>
				<li>Instill one drop of 0.5% proparacaine, allow 3 min for efficacy, and repeat steps 1.3.2 through 1.3.5.</li>
				<li>For cohort 1, apply 30 g&#160;of scleral pressure by ophthalmodynamometer, and acquire the scan while pressure is being applied. Remove the pressure and review the scan for quality. IF acceptable, save, and if not acceptable, repeat this step.</li>
				<li>For cohort 2, apply 5 g of scleral pressure by ophthalmodynamometer, and acquire the scan while pressure is being applied. Remove the pressure and review the scan for quality. IF acceptable, save, and if not acceptable, repeat this step.</li>
				<li>Wait 5 min allowing the eye to recover from the 5 g pressure perturbation.</li>
				<li>For cohort 2, apply 10 g of scleral pressure by ophthalmodynamometer, and acquire the scan while pressure is being applied. Remove the pressure and review the scan for quality. IF acceptable, save, and if not acceptable, repeat this step.</li>
				<li>Record the scan time, condition (i.e., baseline or 10 g) and location in the study record.</li>
			</ol>
			</li>
		</ol>
		</li>
	</ol>
	</li>
</ol>
2. Data Processing
<ol>
	<li>Plug a high-capacity USB storage device into the OCT. Select &#8220;Export&#8221; from the Records menu on the OCT. Designate a file location for exported files on the USB drive. De-select the &#8220;.zip&#8221; option. Enter the patient name for scans to be exported, and select the scans to be exported. Initiate the export.</li>
	<li>When the export completes, unmount the USB drive and remove from the OCT. Plug the high-capacity USB drive containing the exported images into the image processing workstation.</li>
	<li>Launch the image processing program in this case ImageJ.</li>
	<li>Import the raw image data; select &#8220;File -&#62; Import -&#62; Raw&#8221; from the file menu. Select the file with ending in &#8220;_cube_raw.img&#8221; to be processed from the USB drive.</li>
	<li>Save the imported file using a new name, so that the original image data is saved unaltered (http://www.ori.dhhs.gov/education/products/RIandImages).</li>
	<li>Enter the import parameters as follows, Image type: 8 bit, Width: 512, Height: 1,024, Offset: 0; Number of images: 128.</li>
	<li>Select &#8220;Plugins -&#62; Registration -&#62; StackReg&#8221; from the plugins menu. And then select the &#8220;Rigid Body&#8221; option. Then select &#8220;File -&#62; Save As -&#62; TIFF&#8221; to save the aligned stack.</li>
	<li>Select &#8220;Process -&#62; Filters -&#62; Mean 3D&#8221; from the process menu. Enter the parameters X = 1, Y = 1, and Z = 1 as the filter options. Repeat this step twice.</li>
	<li>Select &#8220;File -&#62; Save As -&#62; TIFF&#8221; to save the averaged stack. Spin the mouse wheel to move to frame 1 of the active stack.</li>
	<li>Select &#8220;Process -&#62; Enhance Local Contrast (CLAHE)&#8221; from the Processing menu. Use the parameters block size: 31, histogram bins: 256, Maximum Slope: 5, Mask: none, and check the &#8220;fast&#8221; option. Use the right arrow key to advance to the next frame.</li>
	<li>Move to frame 2 of the active stack and repeat the Process-&#62; Enhance Local Contrast (CLAHE). Repeat until all frames have had contrast enhanced.</li>
	<li>Select &#8220;File -&#62; Save As -&#62; TIFF&#8221; to save the contrast-enhanced stack. Then select &#8220;Image -&#62; Adjust -&#62; Size&#8221; from the Image menu. Deselect the &#8220;Constrain Aspect Ratio&#8221; option, then enter Width: 2,048 and height: 1,024 values.</li>
	<li>Select &#8220;Image -&#62; Transform -&#62; Flip Vertically&#8221; from the Image menu. Then select &#8220;Analyze -&#62; Set Scale&#8221; from the Analyze menu. Enter Distance in pixels: 2,048, Known distance: 4,000, and Pixel Aspect Ratio: 1, and click OK. Select &#8220;File -&#62; Save As -&#62; TIFF&#8221; to save the calibrated 1:1 aspect ratio stack.</li>
	<li>Slowly spin the mouse wheel to visually examine the scans to identify a distinctive vessel crossing to serve as a point of reference within scans. Record the image number and reference frame number in the analysis spreadsheet.</li>
	<li>Press the left arrow key 15 times to go to the first measurement frame. Select the &#8220;Freehand Selections&#8221; tool from the toolbar.</li>
	<li>Place the mouse in the center of SC and press the up arrow. Repeat this step until SC fills the screen.</li>
	<li>Manually segment SC by circling the boundary with the mouse. Hold the control (Ctrl) key and press D for the current image frame. Hold the Ctrl key, and press M. Transcribe the measurement of SC cross-sectional area and measurement frame number to the analysis spreadsheet. De-select the outlined area. Press the right arrow key 3 times. Repeat this step until SC has been measured in 10 frames.</li>
	<li>Press the left arrow key 30 times to return to the first measurement frame.</li>
	<li>Select the straight segment tool from the toolbar.</li>
	<li>Draw a straight line from the anterior-most to posterior-most locations on SC. Hold the control key and press D for the current frame only. Hold the control key and press M. Transcribe SC length and frame number to the analysis spreadsheet. De-select the outlined area. Press the right arrow key 3 times. Repeat this step until SC length has been measured in the same 10 frames as the SC cross-sectional area.</li>
	<li>Insert the equation SC-IOWD = SC-CSA / axial length into the analysis spreadsheet to calculate average SC inner-wall to outer-wall distance (SC-IOWD) by dividing the area measurements by the length measurements.</li>
	<li>Press the left arrow key 30 times to return to the first measurement frame.</li>
	<li>Select the straight segment tool from the toolbar.</li>
	<li>Draw a straight line from the anterior-most on SC to the border of the trabecular meshwork and anterior chamber. Ensure that the line is perpendicular to the border. Hold Ctrl and press D, then M.</li>
	<li>Draw a line from the posterior-most location of SC and the border of the TM and the anterior chamber. Ensure that the line perpendicular to the border. Hold Control and press D, then M.</li>
	<li>Draw a line from the center of SC and the border of the TM and the anterior chamber. Ensure that the line perpendicular to the border. Hold the control key and press D for the current frame only.</li>
	<li>Transcribe the three TM thickness measurements and frame number to the analysis spreadsheet. To do this press the right arrow key 3 times. Repeat this step until TM thickness has been measured in the same 10 frames as the SC cross-sectional area.</li>
</ol>

<ol>
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The Baltimore Eye Survey.</a> Archives of ophthalmolog. 109, 1090-1095 (1991).</li><li>Sommer, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Racial+differences+in+the+cause-specific+prevalence+of+blindness+in+east+Baltimore.">Racial differences in the cause-specific prevalence of blindness in east Baltimore.</a> The New England journal of medicin. 325, 1412-1417 (1991).</li><li>Leske, M. C., Connell, A. M., Wu, S. Y., Hyman, L., Schachat, A. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Distribution+of+intraocular+pressure.">Distribution of intraocular pressure.</a> The Barbados Eye Study. Archives of ophthalmolog. 115, 1051-1057 (1997).</li><li>Leske, M. C., Wu, S. Y., Hennis, A., Honkanen, R., Nemesure, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Risk+factors+for+incident+open-angle+glaucoma:+the+Barbados+Eye+Studies.">Risk factors for incident open-angle glaucoma: the Barbados Eye Studies.</a> Ophthalmolog. 115, 85-93 (2008).</li><li>Mitchell, P., Lee, A. J., Rochtchina, E., Wang, J. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Open-angle+glaucoma+and+systemic+hypertension:+the+blue+mountains+eye+study.">Open-angle glaucoma and systemic hypertension: the blue mountains eye study.</a> Journal of glaucom. 13, 319-326 (2004).</li><li>Mitchell, P., Smith, W., Attebo, K., Healey, P. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prevalence+of+open-angle+glaucoma+in+Australia.+The+Blue+Mountains+Eye+Study.">Prevalence of open-angle glaucoma in Australia. The Blue Mountains Eye Study.</a> Ophthalmolog. 103, 1661-1669 (1996).</li><li>Gabelt, B., Kaufman, P., Kaufman, P. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Adler's Physiology of the Ey. , 237-289 (2003).</li><li>Grant, W. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Experimental+aqueous+perfusion+in+enucleated+human+eyes).">Experimental aqueous perfusion in enucleated human eyes).</a> Archives of ophthalmolog. 69, 783-801 (1963).</li><li>Jocson, V. L., Sears, M. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Experimental+aqueous+perfusion+in+enucleated+human+eyes.+Results+after+obstruction+of+Schlemm's+canal.">Experimental aqueous perfusion in enucleated human eyes. Results after obstruction of Schlemm's canal.</a> Archives of ophthalmolog. 86, 65-71 (1971).</li><li>Maepea, O., Bill, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pressures+in+the+juxtacanalicular+tissue+and+Schlemm's+canal+in+monkeys.">Pressures in the juxtacanalicular tissue and Schlemm's canal in monkeys.</a> Experimental eye researc. 54, 879-883 (1992).</li><li>Johnstone, M. A., Grant, W. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pressure-dependent+changes+in+structures+of+the+aqueous+outflow+system+of+human+and+monkey+eyes.">Pressure-dependent changes in structures of the aqueous outflow system of human and monkey eyes.</a> American journal of ophthalmolog. 75, 365-383 (1973).</li><li>Overby, D. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Altered+mechanobiology+of+Schlemm's+canal+endothelial+cells+in+glaucoma.">Altered mechanobiology of Schlemm's canal endothelial cells in glaucoma.</a> Proceedings of the National Academy of Sciences of the United States of Americ. , (2014).</li><li>Allingham, R. R., de Kater, A. W., Ethier, C. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Schlemm's+canal+and+primary+open+angle+glaucoma:+correlation+between+Schlemm's+canal+dimensions+and+outflow+facility.">Schlemm's canal and primary open angle glaucoma: correlation between Schlemm's canal dimensions and outflow facility.</a> Experimental eye researc. 62, 101-109 (1996).</li><li>Camras, L. J., Stamer, W. D., Epstein, D., Gonzalez, P., Yuan, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Differential+effects+of+trabecular+meshwork+stiffness+on+outflow+facility+in+normal+human+and+porcine+eyes.">Differential effects of trabecular meshwork stiffness on outflow facility in normal human and porcine eyes.</a> Investigative ophthalmolog., &amp; visual scienc. 53, 5242-5250 (2012).</li><li>Last, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Elastic+modulus+determination+of+normal+and+glaucomatous+human+trabecular+meshwork.">Elastic modulus determination of normal and glaucomatous human trabecular meshwork.</a> Investigative ophthalmolog., &amp; visual. 52, 2147-2152 (2011).</li><li>Lutjen-Drecoll, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+morphology+of+the+trabecular+meshwork+in+primate+eyes.">Functional morphology of the trabecular meshwork in primate eyes.</a> Progress in retinal and eye researc. 18, 91-119 (1999).</li><li>Li, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pilocarpine-induced+dilation+of+Schlemm's+canal+and+prevention+of+lumen+collapse+at+elevated+intraocular+pressures+in+living+mice+visualized+by+OCT.">Pilocarpine-induced dilation of Schlemm's canal and prevention of lumen collapse at elevated intraocular pressures in living mice visualized by OCT.</a> Investigative ophthalmolog., &amp; visual scienc. 55, 3737-3746 (2014).</li><li>Francis, A. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Morphometric+analysis+of+aqueous+humor+outflow+structures+with+spectral-domain+optical+coherence+tomography.">Morphometric analysis of aqueous humor outflow structures with spectral-domain optical coherence tomography.</a> Investigative ophthalmolog., &amp; visual. 53, 5198-5207 (2012).</li><li>Kagemann, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=3D+visualization+of+aqueous+humor+outflow+structures+in-situ+in+humans.">3D visualization of aqueous humor outflow structures in-situ in humans.</a> Experimental eye researc. 93, 308-315 (2011).</li><li>Kagemann, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Identification+and+assessment+of+Schlemm's+canal+by+spectral-domain+optical+coherence+tomography.">Identification and assessment of Schlemm's canal by spectral-domain optical coherence tomography.</a> Investigative ophthalmolog., &amp; visual. 51, 4054-4059 (2010).</li><li>Kagemann, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=IOP+Elevation+Reduces+Schlemm's+Canal+Cross-sectional+Area.">IOP Elevation Reduces Schlemm's Canal Cross-sectional Area.</a> Investigative ophthalmolog &amp; visual scienc. , (2014).</li></ol>

Dr. Schuman received royalties for intellectual property licensed by Massachusetts Institute of Technology and Massachusetts Eye and Ear Infirmary to Zeiss, Inc.

The present technique leverages non-invasive observation of the mechanical response of soft tissue to quantify SC collapse. Future work using human cadaver eyes is needed to calibrate tissue deflections actual tissue stiffness after dissection. But, such studies will suffer the same limitations of previous outflow models; specifically, that the contributions of living muscle to tissue tension will not be present. Further calibration in a living mammalian eye model may allow calibration of imaging&#160;and direct measurem...

Glaucoma is the world&#8217;s second leading cause of irreversible blindness1. Elevated intraocular pressure (IOP) is a major causal risk factor for the presence and progression of glaucoma2-7.&#160;IOP is regulated by balance between the formation and outflow of aqueous humor8.&#160;The locations of greatest outflow resistance are the juxtacanicular tissue and the inner wall of Schlemm canal (SC), the interface between SC and the trabecular meshwork (TM) 9-11.&#160;While TM stiffness may contribute to the prevention of SC collapse in the face of IOP elevation,&#160;Overby et al. 12&#160;recently demonstrated that gene expression in glaucoma is altered, resulting in increased SC endothelial stiffening, impeding formation of pores, leading to IOP elevation in glaucomatous eyes13.&#160;TM morphology and stiffness correlate with outflow facility14,15,&#160;emphasizing the need to measure its biomechanical characteristics.
Atomic force microscopy measurements of the TM show elevated stiffness in eyes donated by glaucoma patients (81 kPa) compared with eyes from donors without glaucoma (4.0 kPa) 16,&#160;but these measurements were made in dissected ex vivo tissues. The posterior TM is anchored into the ciliary muscle via anterior tendons of the longitudinal muscle cells which insert into the outer lamellated and cribiform TM17.&#160;Ciliary muscle (CM) activity may increase TM tautness, mimicking elevated TM stiffness17.&#160;The ability to observe alterations in resistance to SC collapse induced by perturbations of smooth muscle has been shown in an animal model18.&#160;We have demonstrated the ability to non-invasively image the primary aqueous humor outflow system in living human eyes distal to and including SC using spectral domain optical coherence tomography (OCT) 19-21.&#160;Using this technique, we have demonstrated the ability to quantify the morphometric response of the TM and SC to acute IOP elevation22.
The overall goal of the method described herein was to quantify the morphometric response of the living outflow tract to acute IOP elevation in living tissues in situ. This technique has the advantage of examining the TM under physiological conditions, which includes contributions of both contractile fiber activity within the TM and CM to TM stiffness, as compared to published measurements made in dissected tissues. The rationale behind applying this technique to observation of the mechanical TM response is that it provides us with otherwise unavailable insights into the mechanical behavior of the TM, which we now know to be linked directly to outflow resistance and IOP regulation13.&#160;To discern the contribution of contractile tissues to overall stiffness, a small cohort of subjects was examined without and with suppression of smooth muscle activity by administration of tropicamide.

<table border="0" cellpadding="0" cellspacing="0">
	<tbody>
		<tr>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Spectral Domain OCT</td>
			<td>Zeiss</td>
			<td>Cirrus</td>
			<td></td>
		</tr>
		<tr>
			<td>Imaging Workstation</td>
			<td>Apple</td>
			<td>iMac</td>
			<td></td>
		</tr>
		<tr>
			<td>Ophthalmodynamometer</td>
			<td colspan="3">(Baillairt Matalene Ophthalmodynamometer, Surgical instruments CO., Inc. New York, NY)</td>
		</tr>
		<tr>
			<td>Image Processing Program</td>
			<td>rsb.info.nih.gov/ij</td>
			<td>ImageJ, FIJI</td>
			<td></td>
		</tr>
	</tbody>
</table>

trabecular meshwork response to pressure elevation in the living human eye

The mechanical characteristics of the trabecular meshwork (TM) are linked to outflow resistance and intraocular pressure (IOP) regulation. The rationale behind this technique is the direct observation of the mechanical response of the TM to acute IOP elevation. Prior to scanning, IOP is measured at baseline and during IOP elevation. The limbus is scanned by spectral-domain optical coherence tomography at baseline and during IOP elevation (ophthalmodynamometer (ODM) applied at 30 g force). Scans are processed to enhance visualization of the aqueous humor outflow pathway using ImageJ. Vascular landmarks are used to identify corresponding locations in baseline and IOP elevation scan volumes. Schlemm canal (SC) cross-sectional area (SC-CSA) and SC length from anterior to posterior along its long axis are measured manually at 10 locations within a 1 mm segment of SC. Mean inner to outer wall distance (short axis length) is calculated as the area of SC divided by its long axis length. To examine the contribution of adjacent tissues to the effect IOP elevations, measurements are repeated without and with smooth muscle relaxation with instillation of tropicamide. TM migration into SC is resisted by TM stiffness, but is enhanced by the support of its attachment to adjacent smooth muscle within the ciliary body. This technique is the first to measure the living human TM response to pressure elevation in situ under physiological conditions within the human eye.

Using these data acquisition and image analysis techniques, the effects of small and large changes in IOP on outflow tract morphological parameters such as SC cross-sectional area are obtained (Figure 1). We can see that high levels of IOP increase produce an observable collapse of SC, as represented by a large reduction in cross-sectional area. The eye appears to be able to accommodate small increases in IOP, as evidenced by the lack of change in SC-CSA (Figure 1). These results show th...

Watch this Scientific Journal Video about Trabecular Meshwork Response to Pressure Elevation in the Living Human Eye at JoVE.com

Trabecular Meshwork Response to Pressure Elevation in the Living Human Eye

Trabecular meshwork (TM) migration into Schlemm&#8217;s canal space can be induced by acute pressure elevation by ophthalmodynamometer, and observed by spectral domain optical coherence tomography. The goal of this method is to quantify the morphometric response of the living outflow tract to acute pressure elevation in living tissues in situ.

The mechanical characteristics of the trabecular meshwork (TM) are linked to outflow resistance and intraocular pressure (IOP) regulation. The rationale ...

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Research

JoVE Journal

Medicine

9.9K ビュー.  University of Pittsburgh School of Medicine. シュレム管の空間内に、小柱網（TM）の移行は、眼底血圧計により、急性の圧力上昇によって誘導され、そしてスペクトル領域光コヒーレンス断層撮影法により観察することができます。この方法の目的は、 その場で生体組織における急性の圧力上昇に住ん流出路の形態学的応答を定量化することです。 

ビデオ: Trabecular Meshwork Response to Pressure Elevation in the Living Human Eye

Epidural Intracranial Pressure Measurement in Rats Using a Fiber-optic Pressure Transducer

Elevated intracranial pressure (ICP) is a significant problem in several forms of ischemic brain injury including stroke, traumatic brain injury and cardiac arrest. This elevation may result in further neurological injury, in the form of transtentorial herniation1,2,3,4, midbrain compression, neurological deficit or increased cerebral infarct2,4. Current therapies are often inadequate to control elevated ICP in the clinical setting5,6,7 . Thus there is a need for accurate methods of ICP measurement in animal models to further our understanding of the basic mechanisms and to develop new treatments for elevated ICP.
In both the clinical and experimental setting ICP cannot be estimated without direct measurement. Several methods of ICP catheter insertion currently exist. Of these the intraventricular catheter has become the clinical 'gold standard' of ICP measurement in humans8. This method involves the partial removal of skull and the instrumentation of the catheter through brain tissue. Consequently, intraventricular catheters have an infection rate of 6-11%9. For this reason, subdural and epidural cannulations have become the preferred methods in animal models of ischemic injury. 
Various ICP measurement techniques have been adapted for animal models, and of these, fluid-filled telemetry catheters10 and solid state catheters are the most frequently used11,12,13,14,15. The fluid-filled systems are prone to developing air bubbles in the line, resulting in false ICP readings. Solid state probes avoid this problem (Figure 1). An additional problem is fitting catheters under the skull or into the ventricles without causing any brain injury that might alter the experimental outcomes. Therefore, we have developed a method that places an ICP catheter contiguous with the epidural space, but avoids the need to insert it between skull and brain. 
An optic fibre pressure catheter (420LP, SAMBA Sensors, Sweden) was used to measure ICP at the epidural location because the location of the pressure sensor (at the very tip of the catheter) was found to produce a high fidelity ICP signal in this model. There are other manufacturers of similar optic fibre technologies13 that may be used with our methodology. Alternative solid state catheters, which have the pressure sensor located at the side of the catheter tip, would not be appropriate for this model as the signal would be dampened by the presence of the monitoring screw. 
Here, we present a relatively simple and accurate method to measure ICP. This method can be used across a wide range of ICP related animal models.

A novel technique to record the pressures within the skull is described. The minimally invasive method uses a fibre-optic pressure sensing system to accurately measure intracranial pressure (ICP) in anaesthetized rats without causing significant brain trauma. The technique may be used in a wide range of experimental models.

Elevated intracranial pressure (ICP) is a significant problem in several forms of ischemic brain injury including stroke, traumatic brain injury and ...

Subretinal Injection of Gene Therapy Vectors and Stem Cells in the Perinatal Mouse Eye

The loss of sight affects approximately 3.4 million people in the United States and is expected to increase in the upcoming years.1 Recently, gene therapy and stem cell transplantations have become key therapeutic tools for treating blindness resulting from retinal degenerative diseases. Several forms of autologous transplantation for age-related macular degeneration (AMD), such as iris pigment epithelial cell transplantation, have generated encouraging results, and human clinical trials have begun for other forms of gene and stem cell therapies.2 These include RPE65 gene replacement therapy in patients with Leber's congenital amaurosis and an RPE cell transplantation using human embryonic stem (ES) cells in Stargardt's disease.3-4 Now that there are gene therapy vectors and stem cells available for treating patients with retinal diseases, it is important to verify these potential therapies in animal models before applying them in human studies. The mouse has become an important scientific model for testing the therapeutic efficacy of gene therapy vectors and stem cell transplantation in the eye.5-8 In this video article, we present a technique to inject gene therapy vectors or stem cells into the subretinal space of the mouse eye while minimizing damage to the surrounding tissue.

This surgical technique illustrates the injection of gene therapy vectors and stem cells into the subretinal space of the mouse eye.

The loss of sight affects approximately 3.4 million people in the United States and is expected to increase in the upcoming years.1 Recently, gene therapy ...

Development of an Audio-based Virtual Gaming Environment to Assist with Navigation Skills in the Blind

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind. Using only audio based cues and set within the context of a video game metaphor, users gather relevant spatial information regarding a building's layout. This allows the user to develop an accurate spatial cognitive map of a large-scale three-dimensional space that can be manipulated for the purposes of a real indoor navigation task. After game play, participants are then assessed on their ability to navigate within the target physical building represented in the game. Preliminary results suggest that early blind users were able to acquire relevant information regarding the spatial layout of a previously unfamiliar building as indexed by their performance on a series of navigation tasks. These tasks included path finding through the virtual and physical building, as well as a series of drop off tasks. We find that the immersive and highly interactive nature of the AbES software appears to greatly engage the blind user to actively explore the virtual environment. Applications of this approach may extend to larger populations of visually impaired individuals.

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind.

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind. Using only audio ...

Assessing Myogenic Response and Vasoactivity In Resistance Mesenteric Arteries Using Pressure Myography

Small resistance arteries constrict and dilate respectively in response to increased or decreased intraluminal pressure; this phenomenon known as myogenic response is a key regulator of local blood flow. In isobaric conditions small resistance arteries develop sustained constriction known as myogenic tone (MT), which is a major determinant of systemic vascular resistance (SVR). Hence, ex vivo&#160;pressurized preparations of small resistance arteries are major tools to study microvascular function in near-physiological states. To achieve this, a freshly isolated intact segment of a small resistance artery (diameter ~260 &#956;m) is mounted onto two small glass cannulas and pressurized. These arterial preparations retain most in vivo characteristics and permit assessment of vascular tone in real-time. Here we provide a detailed protocol for assessing vasoactivity in pressurized small resistance mesenteric arteries from rats; these arteries develop sustained vasoconstriction - approximately 25% of maximal diameter - when pressurized at 70 mmHg. These arterial preparations may be used to study the effect of investigational compounds on relationship between intra-arterial pressure and vasoactivity and determine changes in microvascular function in animal models of various diseases.

Pressure myography is used to assess vasoactivity of small arteries that develop sustained constriction when pressurized. This manuscript provides a detailed protocol to assess in isolated segments of small mesenteric arteries from rats, vasoactivity and the effect of intraluminal pressure on vascular diameter.

Small resistance arteries constrict and dilate respectively in response to increased or decreased intraluminal pressure; this phenomenon known as myogenic ...

Intrauterine Telemetry to Measure Mouse Contractile Pressure In Vivo

A complex integration of molecular and electrical signals is needed to transform a quiescent uterus into a contractile organ at the end of pregnancy. Despite the discovery of key regulators of uterine contractility, this process is still not fully understood. Transgenic mice provide an ideal model in which to study parturition. Previously, the only method to study uterine contractility in the mouse was ex vivo isometric tension recordings, which are suboptimal for several reasons. The uterus must be removed from its physiological environment, a limited time course of investigation is possible, and the mice must be sacrificed. The recent development of radiometric telemetry has allowed for longitudinal, real-time measurements of in vivo intrauterine pressure in mice. Here, the implantation of an intrauterine telemeter to measure pressure changes in the mouse uterus from mid-pregnancy until delivery is described. By comparing differences in pressures between wild type and transgenic mice, the physiological impact of a gene of interest can be elucidated. This technique should expedite the development of therapeutics used to treat myometrial disorders during pregnancy, including preterm labor.

Intrauterine Telemetry to Measure Mouse Contractile Pressure In Vivo

This manuscript provides a protocol for implanting telemeters in the mouse for the purpose of measuring intrauterine pressures during pregnancy.

A complex integration of molecular and electrical signals is needed to transform a quiescent uterus into a contractile organ at the end of pregnancy. ...

Cardiac Catheterization in Mice to Measure the Pressure Volume Relationship: Investigating the Bowditch Effect

Animal models that mimic human cardiac disorders have been created to test potential therapeutic strategies. A key component to evaluating these strategies is to examine their effects on heart function. There are several techniques to measure in vivo cardiac mechanics (e.g., echocardiography, pressure/volume relations, etc.). Compared to echocardiography, real-time left ventricular (LV) pressure/volume analysis via catheterization is more precise and insightful in assessing LV function. Additionally, LV pressure/volume analysis provides the ability to instantaneously record changes during manipulations of contractility (e.g., &#946;-adrenergic stimulation) and pathological insults (e.g., ischemia/reperfusion injury). In addition to the maximum (+dP/dt) and minimum (-dP/dt) rate of pressure change in the LV, an accurate assessment of LV function via several load-independent indexes (e.g., end systolic pressure volume relationship and preload recruitable stroke work) can be attained. Heart rate has a significant effect on LV contractility such that an increase in the heart rate is the primary mechanism to increase cardiac output (i.e., Bowditch effect). Thus, when comparing hemodynamics between experimental groups, it is necessary to have similar heart rates. Furthermore, a hallmark of many cardiomyopathy models is a decrease in contractile reserve (i.e., decreased Bowditch effect). Consequently, vital information can be obtained by determining the effects of increasing heart rate on contractility. Our and others data has demonstrated that the neuronal nitric oxide synthase (NOS1) knockout mouse has decreased contractility. Here we describe the procedure of measuring LV pressure/volume with increasing heart rates using the NOS1 knockout mouse model.

This article describes the measurement of murine left ventricular function via pressure/volume analysis at different heart rates.

Animal models that mimic human cardiac disorders have been created to test potential therapeutic strategies. A key component to evaluating these ...

A Mouse Model of Retinal Ischemia-Reperfusion Injury Through Elevation of Intraocular Pressure

Retinal ischemia-reperfusion (I/R) is a pathophysiological process contributing to cellular damage in multiple ocular conditions, including glaucoma, diabetic retinopathy, and retinal vascular occlusions. Rodent models of I/R injury are providing significant insights into mechanisms and treatment strategies for human I/R injury, especially with regard to neurodegenerative damage in the retinal neurovascular unit. Presented here is a protocol for inducing retinal I/R injury in mice through elevation of intraocular pressure (IOP). In this protocol, the ocular anterior chamber is cannulated with a needle, through which flows the drip of an elevated saline reservoir. Using this drip to raise IOP above systolic arterial blood pressure, a practitioner temporarily halts inner retinal blood flow (ischemia). When circulation is reinstated (reperfusion) by removal of the cannula, severe cellular damage ensues, resulting ultimately in retinal neurodegeneration. Recent studies demonstrate inflammation, vascular permeability, and capillary degeneration as additional elements of this model. Compared to alternative retinal I/R methodologies, such as retinal arterial ligation, retinal I/R injury by elevated IOP offers advantages in its&#160;anatomical specificity, experimental tractability, and technical accessibility, presenting itself as a valuable tool for examining neuronal pathogenesis and therapy in the retinal neurovascular unit.

This article describes a procedure for inducing retinal ischemia-reperfusion injury by elevated intraocular pressure in mice. Retinal ischemia-reperfusion injury by elevated intraocular pressure serves to model human pathologies characterized by compromised oxygen and nutrient delivery in the retina, enabling researchers to examine potential cellular mechanisms and treatments for human diseases of the retinal neurovascular unit.

Retinal ischemia-reperfusion (I/R) is a pathophysiological process contributing to cellular damage in multiple ocular conditions, including glaucoma, ...

Precision Implementation of Minimal Erythema Dose (MED) Testing to Assess Individual Variation in Human Inflammatory Response

Minimal erythema dose (MED) testing is frequently used in clinical settings for determining the smallest amount of ultraviolet (UV) irradiation necessary to produce erythema (inflammatory reddening) on the surface of the skin. In this context, the MED is regarded as a key factor in determining starting doses for UV phototherapy for common skin conditions such as psoriasis and eczema. In research settings, MED testing also has potential to be a powerful tool for assessing within- and between-persons variation in inflammatory responses. However, MED testing has not been widely adopted for use in research settings, likely owing to a lack of published guidelines, which is a barrier to obtaining reproducible results from this assay. Also, protocols and equipment for establishing MED vary widely, making it difficult to compare results across laboratories. Here, we describe a precise and reproducible method to induce and measure superficial erythema using newly designed protocols and methods that can easily be adapted to other equipment and laboratory environments. The method described here includes detail on procedures that will allow extrapolation of a standardized dosage schedule to other equipment so that this protocol can be adapted to any UV radiation source.

Precision Implementation of Minimal Erythema Dose MED Testing to Assess Individual Variation in Human Inflammatory Response

Minimal erythema dose (MED) testing is used to establish dosage schedules for ultraviolet radiation phototherapy. It can assess individual variation in inflammatory response but lacks methodology for achieving reproducible results. Here, we present a precision implementation of MED and demonstrate its ability to capture individual variation in inflammatory response.

Minimal erythema dose (MED) testing is frequently used in clinical settings for determining the smallest amount of ultraviolet (UV) irradiation necessary ...

Characterization of a Novel Human Organotypic Retinal Culture Technique

Previous human organotypic retinal culture (HORC) models have utilized detached retinas; however, without the structural support conferred by retinal pigment epithelium-choroid (RPE-choroid) and sclera, the integrity of the fragile retina can easily be compromised. The aim of this study was to develop a novel HORC model that contains the retina, RPE-choroid and sclera to maintain retinal integrity when culturing retinal explants.
After cutting circumferentially along the limbus to remove iris and lens, four deep incisions were made to flatten the eyecup. In contrast to previous HORC protocols, a trephine was used to cut through not only the retina but also the RPE-choroid and sclera. The resultant triple-layered explants were cultured for 72 h. Hematoxylin and Eosin staining (H&#38;E) was used to assess anatomical structures and retinal explants were further characterized by immunohistochemistry (IHC) for apoptosis, M&#252;ller cell integrity and retinal inflammation. To confirm the possibility of disease induction, explants were exposed to high glucose (HG) and pro-inflammatory cytokines (Cyt), to mimic diabetic retinopathy (DR). The Luminex magnetic bead assay was used to measure DR-related cytokines released into the culture medium.
H&#38;E staining revealed distinct retinal lamellae and compact nuclei in retinal explants with the underlying RPE-choroid and sclera, while retinas without the underlying structures exhibited reduced thickness and severe nuclei loss. IHC results indicated absence of apoptosis and retinal inflammation as well as preserved M&#252;ller cell integrity. The Luminex&#160;assays showed significantly increased secretion of DR-associated pro-inflammatory cytokines in retinal explants exposed to HG + Cyt relative to baseline levels at 24 h.
We successfully developed and characterized a novel HORC protocol in which retinal integrity was preserved without apoptosis or retinal inflammation. Moreover, the induced secretion of DR-associated pro-inflammatory biomarkers when exposing retinal explants to HG + Cyt suggests that this model could be used for clinically translatable retinal disease studies.

This study aims to develop a novel human organotypic retinal culture (HORC) model that prevents compromising retinal integrity during explant handling. This is achieved by culturing the retina with the overlying vitreous and the underlying retinal pigment&#160;epithelium-choroid (RPE-choroid) and sclera.

Previous human organotypic retinal culture (HORC) models have utilized detached retinas; however, without the structural support conferred by retinal ...

Cardiac Response to &#946;-Adrenergic Stimulation Determined by Pressure-Volume Loop Analysis

Determination of the cardiac function is a robust endpoint analysis in animal models of cardiovascular diseases in order to characterize effects of specific treatments on the heart. Due to the feasibility of genetic manipulations the mouse has become the most common mammalian animal model to study cardiac function and to search for new potential therapeutic targets. Here we describe a protocol to determine cardiac function&#160;in vivo using pressure-volume loop measurements and analysis during basal conditions and under &#946;-adrenergic stimulation by intravenous infusion of increasing concentrations of isoproterenol. We provide a refined protocol including ventilation support taking into account the positive end-expiratory pressure to ameliorate negative effects during open-chest measurements, and potent analgesia (Buprenorphine) to avoid uncontrollable myocardial stress evoked by pain during the procedure. All together the detailed description of the procedure and discussion about possible pitfalls enables highly standardized and reproducible pressure-volume loop analysis, reducing the exclusion of animals from the experimental cohort by preventing possible methodological bias.

Cardiac Response to &amp;#946;-Adrenergic Stimulation Determined by Pressure-Volume Loop Analysis

Here we describe a cardiac pressure-volume loop analysis under increasing doses of intravenously infused isoproterenol to determine the intrinsic cardiac function and the &#946;-adrenergic reserve in mice. We use a modified open-chest approach for the pressure-volume loop measurements, in which we include ventilation with positive end-expiratory pressure.

Determination of the cardiac function is a robust endpoint analysis in animal models of cardiovascular diseases in order to characterize effects of ...