Synopsis
The microstructural organization and compositions of
the corneoscleral shell are central to ocular biomechanics, and are important
in diseases such as glaucoma and myopia. In this study, we showed that T2-weighted
MRI, diffusion tensor MRI and magnetization transfer MRI can be used to detect
and differentiate microstructural and macromolecular changes in freshly prepared
ovine eyes under different abnormal conditions including intraocular pressure loading,
cross-linking and glycosaminoglycans depletion. We also demonstrated the
feasibility of assessing the human sclera with in vivo MRI. Multi-modal MRI may
be useful for evaluating the biomechanical and pathophysiological mechanisms in
the corneoscleral shell non-invasively and quantitatively. Purpose
The sclera and
cornea are dense and fibrous connective tissues that form the outer coat of the
eye, which act to support and protect the eye from the surrounding
environments. These load-bearing connective tissues can dynamically interact
with changing physiological conditions
1, 2. Under elevated intraocular
pressure (IOP), the corneoscleral shell transfers tensile, compression and
shear stresses on the optic nerve head, and may contribute to the deformation of
optic nerve axons and neurodegeneration in the visual system in glaucoma
3-5. To
date, limited non-invasive imaging techniques are available for determining the
microstructural organization and compositions of the corneoscleral shell globally
and quantitatively in different environments, which are critical for understanding
the dynamics and the biomechanical and biochemical properties of the eye
6. In
this study, we hypothesized that T2-weighted MRI (T2WI), diffusion tensor MRI (DTI)
and magnetization transfer MRI (MTI) can detect and differentiate
microstructural and macromolecular changes of the sclera and cornea in three
experiments: #1: stepwise changes in biomechanical IOP loading (mimicking
ocular hypertension
7); #2: cross-linking (mimicking aging conditions
8 and
corneoscleral stiffening treatment
9, 10); and #3: glycosaminoglycans cleavage (mimicking
glaucoma and myopic conditions
11). In a fourth experiment, we demonstrated in
vivo the feasibility of magic-angle enhancement in the human sclera for
examining the fibrous microstructures in the eye using T2*-weighted MRI (T2*WI).
Methods
Experiment
#1:
T2 mapping was performed to 12 fresh, unfixed ovine eyes undergoing anterior
chamber perfusion in the 9.4-Tesla MRI scanner using a plastic cannula
connected to a saline bag and a pressure transducer (Figure 1). Six eyes were
loaded at 0-40mmHg by raising the saline bag at different heights, followed by
unpressurization back to 0mmHg. Six other eyes were cannulated but kept at 0mmHg
as an unloaded control. Experiments #2 and #3: 16 ovine eyes were dissected
at the central globes to give 4 sclera and 4 cornea tissue sections per eye. The
tissue sections were treated with various concentrations of glyceraldehyde for
cross-linking (#2) and chondroitinase-ABC for glycosaminoglycans depletion (#3)
at 37
oC for 12 hours followed by T2WI, DTI and MTI assessments.
All ovine eye
experiments were performed using a 9.4-Tesla Varian/Agilent MRI scanner with
the following imaging parameters. i) T2 mapping: TR/TE=1000/9.48ms, EST=9.48ms,
number of echoes=5, in-plane resolution=130×130µm
2, slice
thickness=1mm; ii) DTI: 2 non-diffusion-weighted images and 12 diffusion
gradient directions at b=1000s/mm
2, δ/Δ=5/17ms, TR/TE=2300/27.8ms;
iii) MTI: 9.5µT saturation pulses at 6000Hz off-resonance and 150ms pulse length,
TR/TE=1500/8.43ms. Both DTI and MTI shared the same slice geometry, with
in-plane resolution=140×140µm
2 and slice thickness=1mm.
Experiment
#4:
A healthy adult subject fixated his eyes at 3 orientations (up, center, bottom)
in the 3-Tesla Siemens Trio MRI scanner, and sagittal T2* mapping was performed
to the right eye (IOP=11mmHg) using a 2D FLASH sequence, with TR/TE=50/3.52ms, EST=3.17ms,
number of echoes=5, in-plane resolution=375×375µm
2, slice thickness=2mm
and scanning duration=3min.
Results
In the ovine experiments, T2 in sclera
and cornea increased non-linearly with biomechanical IOP loading at 0-40mmHg
and remained higher than unloaded tissues after being unpressurized (Figure 2).
Increasing dosages of glyceraldehyde (Figure 3) and chondroitinase-ABC
treatments (Figure 4) decreased diffusivities and increased magnetization
transfer in cornea. Glyceraldehyde also increased magnetization transfer in
sclera (Figure 3).
In the human experiment, T2* of the posterior
sclera increased with increasing angle to the main magnetic field from 0
o
to 55
o (the magic angle) as the subject fixated at different
orientations (Figure 5).
Discussion and Conclusion
The T2 increase in
IOP-loaded fresh ocular tissues might be explained by the diminishing spin
dephasing between increasingly distant neighboring protons during collagen
fiber straightening
6, 12. More importantly, the non-linearity of T2 changes echoed
with recent studies showing non-linear uncrimping of collagen fibrils in the
corneoscleral shell with IOP loading
13, 14. T2 of IOP-loaded
tissues remained high after being unpressurized suggestive of MRI
detection of hysteresis or hydraulic effects
15, 16.
The
increasing magnetization transfer and reducing diffusivity in the glyceraldehyde-treated
ocular tissues suggested that MTI and DTI could characterize
the state of collagen cross-linking such as increasing cross-linking
packing density
17 and reducing
permeability
18 in the eye under different physiological conditions. DTI and MTI may also detect
glycosaminoglycan removal which is often a cause of altered creep and stiffness
in glaucoma and myopic eyes
19. As our multi-modal imaging techniques
share similar physical principles in both high-field MRI and clinical MRI,
our initial magic angle-enhanced MRI demonstration to detect the fibrous
tissues in the human eye opened up the possibility for future non-invasive multi-modal
MRI assessments of the corneoscleral biomechanics in the living human eyes,
which may help identify new modifiable risk factors and guide vision
preservation in a variety of ophthalmic diseases.
Acknowledgements
This work was supported by the National
Institutes of Health Contracts P30-EY008098, R01-EY023966 and UL1-TR000005
(Bethesda, Maryland); BrightFocus Foundation G2013077 (Clarksburg, Maryland);
Alcon Research Institute Young Investigator Grant (Fort Worth, Texas); Eye and
Ear Foundation (Pittsburgh, Pennsylvania); and Research to Prevent Blindness (New
York, New York).References
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