Glaucoma and lymphatics surgery

The vital drainage canals for aqueous - lymphatics. von Daljit Singh. The informations of the conjunctival lymphatics are rather neglected or recive an insignificant mention in ophtalmic textbooks. It is difficult to find something about them also in glaucoma study handbooks. Over 50 % of aqueous drainage is through uveo-scleral outflow. Only lymphatics are structures which shall drain the out-coming aqueous, normally and after a filtration surgery. The destroy of lymphatics can cause a dangerous complications after glaucoma surgery. Under a silt lamp microscope, the lymphatics create wrinkles of the light reflex. The attendance of pigment at the limbus highlights is the attendance of the lymphatics. The interesting patterns can be charted in some cases. The cannals can be visible all around the limbus. An art of injury including surgical trauma can introduce blood inside the lymphatics, marking them beautifully. Sometimes may be observed lymphatics coursing over the blood vessels and running parallel to the edge. The lymphatics may be filled up by a microtrack filtration close to the limbus. Before surgery, inside the operation theater, subconjunctival hydrocortisone injection is applicated into the lymphatics, what marked them. The injury at the limbus may fill up the neigbour lymphatics. Lymphatics may be filled up also by air injection. The injection with trypan blue at the limbus can make a border of the large network of conjunctival lymphatics. The tripan blue may sometimes fill up a cicrular canal in the circumferential part of the cornea in the place where one finds clear interval of arcus senilis. Only in emergency cases the surgery is need to be done upon by the microtrack. When the trypan blue is injected in the anterior chamber on the next day, there is beautifully noticable the conjunctival network of lymphatics. The ophtalmologists should to be aware of lymphatics. They can be a way to succesfully glaucoma surgery. The future operations may be designed around them.