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Hydrostatic Pressure of the Suprachoroidal Space

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Hydrostatic Pressure of the Suprachoroidal Space Investigative Ophthalmology & Visual Science, Vol. 30, No. 2, February 1989 Copyright © Association for Research in Vision and Ophthalmology Hydrostatic Pressure of the Suprachoroidal Space Kozuyuki Emi, Jonathan E. Pederson, and Carol B. Toris The hydrostatic pressure of the suprachoroidal space was measured in 18 cynomolgus monkey eyes by one of two methods: (1) direct cannulation, or (2) silicone sponge implantation. The intraocular pressure (IOP) and suprachoroidal pressure were monitored simultaneously with the IOP being held at various levels between 5 and 60 mm Hg. In eyes with direct cannulation, at an IOP of 15 mm Hg, the pressure in the anterior suprachoroidal (supraciliary) space was 0.8 ± 0.2 mm Hg (n = 6, mean ± SE) below the IOP, but the posterior suprachoroidal pressure was 3.7 ± 0.4 mm Hg (n = 8) below the IOP. The suprachoroidal pressure in eyes with silicone sponge implant was 4.7 ± 0.6 (n = 7) mm Hg below the IOP. A change in IOP produced a corresponding change in the supraciliary space pressure. However, the pressure difference between the anterior chamber and the posterior suprachoroidal space increased at higher IOP. This pressure differential is the driving force for uveoscleral outflow. Invest Ophthalmol Vis Sci 30:233-238,1989 The suprachoroid lies between the choroid and the conformed to the ARVO Resolution on the Use of sclera and is composed of closely packed layers of Animals in Research. Each monkey was anesthetized long pigmented processes derived from each tissue.1 with intramuscular ketamine hydrochloride (20 The suprachoroidal space is a potential space provid- mg/kg) and intravenous sodium pentobarbital (25 ing a pathway for uveoscleral outflow and becomes mg/kg). Pupils were dilated with phenylephrine hy- an actual space in choroidal detachment. The hydro- drochloride and cyclopentolate hydrochloride. static pressure in the suprachoroidal space is an im- portant parameter for understanding intraocular Direct Cannulation with Polyethylene Tubing fluid dynamics and the mechanism of choroidal de- A deep lateral canthotomy and a temporal peri- tachment. The suprachoroidal hydrostatic pressure tomy were performed, followed by two full-thickness was first measured in 1961 by van Alphen, who in- scleral incisions 1.0 mm wide, one made radially at serted a needle into the suprachoroidal of cats. He the inferotemporal sclera 7 mm posterior to the reported that the suprachoroidal space pressure limbus and another made circumferentially at the su- (SCSP) was 1 or 2 mm Hg less than the intraocular perotemporal sclera 2 mm posterior to the limbus. pressure and that the pressure difference was unaf- After removal of a small amount of aqueous fluid fected by intraocular pressure.2 with a 3 mm needle knife, a tunnel was made into the In this study, the suprachoroidal space hydrostatic suprachoroidal space with a 0.5 mm fine spatula. A pressure (SCSP) was measured in monkeys with two tapered polyethylene tube (O.D. about 0.25 mm, I.D. different methods in order to reevaluate the intersti- about 0.05 mm), was inserted through the radial tial fluid hydrostatic pressure and to investigate the scleral incision into the posterior suprachoroidal relationship between suprachoroidal hydrostatic space (beneath the posterior pole) and fixed with 8-0 pressure and intraocular pressure. silk suture. The localization of the cannula was ob- served as a elevated retinal reflex line on the posterior Materials and Methods fundus. Another tapered cannula was introduced Nine cynomolgus monkeys of either sex weighing through the anterior scleral incision into the supracil- 3.2 to 4.5 kg were used in this study. Animal usage iary space and fixed as well. A 27-gauge needle con- nected to polyethylene tubing was inserted into the anterior chamber to monitor the intraocular pres- From the Department of Ophthalmology, University of Minne- sure. Another 27-gauge needle, which was connected sota, Minneapolis, Minnesota. to a fluid reservoir filled with sterile physiological Presented in part at the Association for Research in Vision and Ophthalmology meeting, May 2, 1988, Sarasota, Florida. saline, was introduced into the vitreous cavity Supported by NIH grant EY-03277. through the pars plana in order to control the intra- Submitted for publication: July 6, 1988; accepted September 2, ocular pressure. Each tubing was filled with sterile 1988. saline and connected to a 4-channel pressure trans- Reprint requests: Kazuyuki Emi, MD, Department of Ophthal- ducer (7754B, Hewlett Packard, Waltham, MA). The mology, University of Minnesota, Box 493 UMHC, Minneapolis, MN 55455. hydrostatic pressures at four different locations (ante- 230 Downloaded from iovs.arvojournals.org on 09/26/2021 234 INVESTIGATIVE OPHTHALMOLOGY b VISUAL SCIENCE / February 1989 Vol. 30 anterior chamber posterioi suprachoroidal space Fig. 1. Cannula and needle placement for direct cannulation Fig. 3. Needle placement for sponge implant method. method. rior chamber, vitreous cavity, supraciliary space, su- cone sponge, 5X7X7 mm, (Scleral Sponge II, Dow prachoroidal space) were monitored simultaneously Corning, Midland, MI) was hollowed out (the inner (Fig. 1). The cannula introduced into the posterior cavity was about 3X5X5 mm.). Under intravenous suprachoroidal space was visible in the fundus (Fig. sodium pentobarbital anesthesia, a circumferential 2). For the first hour after the cannula placement, the scleral incision was made 7 mm wide on the temporal pressure measurement was performed without infu- surface, 7 mm from the limbus, avoiding the vortex sion. After the pressures became stable, the IOP was veins. After 0.5 ml of vitreous was aspirated through artificially maintained at several levels (10 mm Hg to the nasal pars plana, the choroidal tissue was gently 60 mm Hg) for 15 to 30 min by changing the height separated from the sclera using a dull spatula (0.5 of the reservoir bottle. Then the fluid infusion was mm). The silicone sponge was implanted in the su- stopped to allow recovery of spontaneous IOP. Fi- prachoroidal space and the scleral incision was su- nally, the IOP was lowered to 5 mm Hg by aspirating tured tightly with 8-0 silk sutures. At least 6 weeks aqueous humour from the cannula inserted into the after the sponge implantation, a 27-gauge needle was anterior chamber. introduced inside the implanted sponge capsule. Then, 27-gauge needles were introduced into the an- terior chamber and the vitreous cavity (Fig. 3). The Silicone Sponge Implantation hydrostatic pressure measurements were made in the After the cannulation study, the right eyes of eight same manner as in the cannula study. At the termina- monkeys were used for sponge implantation. A sili- tion of the pressure measurements, about 50 jtl of sponge capsule fluid was aspirated and a plasma sam- ple was collected. The protein concentrations of the plasma and capsule fluid were measured by the Lowry method.3 Four eyes with sponge implants were enucleated and examined histologically. Results Spontaneous Hydrostatic Pressure Difference About 40 min was required for the pressures to stabilize after cannulation. The intraocular pressure (IOP) stabilized at pressures between 4.5 and 13.5 mm Hg (average 9.3 mm Hg) under the intravenous pentobarbital anesthesia. As shown in Table 1, with direct cannulation, the hydrostatic pressure in the su- Fig. 2. Photograph of monkey fundus showing cannula in the praciliary space was 0.9 ± 0.2 mm Hg (mean ± SE, n posterior suprachoroidal space (arrows). = 9) less than the IOP (paired student t-test: P Downloaded from iovs.arvojournals.org on 09/26/2021 No. 2 SUPRACHOROIDAL SPACE PRESSURE / Emi er ol 235 Table 1. Spontaneous pressure measurements (mm Hg) Anterior Posterior cannula cannula Sponge IOP 9.4 ± 0.9 (9)* 9.2 ±0.9(10)t 9.3±1.2(7)f SCSP 8.4 ± 0.9 (9)* 5.8±0.5(10)t 5.1 ±1.2 (7)* IOP-SCSP 0.9 ± 0.2 (9)§" 3.5 ± 0.5 (10)§ 4.2 ±0.5(7)" Each value indicates mean ± SE. ( ) = n. IOP: intraocular pressure. SCSP: suprachoroidal space pressure. *P < 0.05, ff < 0.001 (paired student t- test). §•"/> < 0.001 (unpaired student t-test). < 0.05). The hydrostatic pressure in the posterior su- prachoroidal space was 3.5 ± 0.5 mm Hg (n = 10) less than the IOP (paired student t-test: P < 0.001) and significantly lower than the hydrostatic pressure in the supraciliary space (unpaired student t-test: P < 0.001). The hydrostatic pressure in the sponge was 4.2 ± 0.5 mm Hg (n = 7) less than the IOP (P < 0.001) and also significantly lower than the supra- INTRAOCULAR PRESSURE (mm Hg) ciliary pressure (P < 0.001). There was no significant Fig. 4. Correlation between intraocular pressure and supraciliary difference between the hydrostatic pressure in the or suprachoroidal space pressure. Closed squares (sponge): mean pressure inside sponge. Open circles (posterior cannula): mean posterior cannula and the pressure in the sponge. pressure in cannula in posterior suprachoroidal space. Crosses (an- terior cannula): mean pressure in cannula in supraciliary space. Effect of Raising the IOP on the SCSP Vertical bars indicate standard error. Solid straight line has unity slope. After the pressures stabilized spontaneously, the reservoir bottle was elevated to increase the IOP to a higher level. As the IOP increased, the supraciliary space pressure (anterior cannulation), the supracho- roidal space pressure (posterior cannulation) and the suprachoroidal pressure (sponge implantation) also increased but the magnitude of increase varied. An increase in IOP produced almost the same increase in the supraciliary space pressure but a smaller increase was measured in the SCSP with both posterior can- nulation and sponge implantation (Fig. 4). By raising the IOP from 15 mm Hg to 60 mm Hg, the pressure difference between the IOP and the suprachoroidal hydrostatic pressure increased from 3.7 ± 0.4 mm Hg (n = 8) to 10.2 ± 1.3 mm Hg (n = 7) in the posterior cannulation (P < 0.001) and from 4.7 ± 0.6 mm Hg (n = 7) to 10.2 ± 0.8 mm Hg (n = 7) in the sponge implantation {P < 0.001, Fig.
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