title: [Fine structure of conjunctival lymphatic vessel valves].
abstract: BACKGROUND
  Lymphatic valves are due to ensure a zentripetal flow of lymph. The majority of the authors regard these valves as bicuspid structures with joint insertion points of the downstream localized free valvular edges. Because of that valvular structure a retrograde flow of lymph is impossible. Observations of our own however demonstrated retrograde flow of fluid under physiological conditions. In the following paper the structure of conjunctival lymphatic valves should be investigated or rather those structures, which were regarded as valves hitherto. Are there segmental connections, which allow retrograde flow of lymph? Is a regulation of lymph flow possible without self-acting valves?
  
  
  METHODS
  In the conjunctiva of bovine post-mortem eyes (n = 100) segmental connections of lymphatic vessels with a diameter of less than 1 mm were opened specifically under control of slit lamp microscope after having undertaken an interstitial double contrast lymphography (solution of Berliner Blue/air). Some of these preparations (n = 20) could be investigated further on with the scanning electron microscope. That procedure allowed to make the patterns of flow and vessels structures in the beginnings of the lymphatic system observed with the slit lamp microscope congruent with those structures shown by the scanning electron microscope.
  
  
  RESULTS
  The following segmental connections could be demonstrated: 1. Lymphatic vessels, which flow like a pipe into the wall of another segment. 2. Laterally arranged oval connections with valve resembling an aperture. 3. Segments of lymphatic vessels arranged in a line, which flow into one another between two hump-shaped protrusions with bicuspid valvular structures. Also the existence of different connecting structures ("valves") in one segment ("gear segment") were observed. In bulbus-like segmental connections arranged one behind the other with two valvular leaflets it could be demonstrated by scanning electron microscopy, that the two leaflets were attached apart at the vessel wall. That divergence to the previous models of lymphatic valves means, that these valvular leaflets cannot work as self-acting valves and prevent retrograde flow.
  
  
  CONCLUSIONS
  However according to the valveless model of Libau a directed regulation of flow is possible. Perhaps the valvular structures described above play an important part by the interaction between the endothelium of lymphatic vessels and the substances transported in the lymph. The variety of segmental connections, the network of vessels with different diameters, which seem to be connected by feed-back, demand a new way of looking at the initial lymph flow.
authors.affiliation: Universitätsaugenklinik Düsseldorf.
authors.forename: J
authors.initials: J
authors.lastname: Grüntzig
authors.forename: A
authors.initials: A
authors.lastname: Djajadisastra
authors.forename: D
authors.initials: D
authors.lastname: Uthoff
authors.forename: H
authors.initials: H
authors.lastname: Mehlhorn
mesh_terms: D000818:Animals; D002417:Cattle; D003228:Conjunctiva / Q000033:anatomy & histology*; D008208:Lymphatic System / Q000033:anatomy & histology*; D008220:Lymphography; D008855:Microscopy, Electron, Scanning; D012016:Reference Values
vernacular_title: Feinstruktur konjunktivaler Lymphgefässklappen.