By George A. Cioffi, MD
This part underwent significant revision for the 2008-2009 edition.Topics mentioned comprise the epidemiologic elements of glaucoma; hereditary and genetic elements; intraocular strain and aqueous humor dynamics; scientific review; scientific administration of and surgical remedy for glaucoma. This version comprises up-to-date tables and revised photos, in addition to quite a few new pictures illustrating either ailment entities and surgical thoughts.
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Additional info for 2008-2009 Basic and Clinical Science Course: Section 10: Glaucoma (Basic and Clinical Science Course 2008-2009)
As with outflow facility, this ratio is affected by age and by ocular health. The meshwork is classically divided into 3 parts (Fig 2-2). The uveal part is adjacent to the anterior chamber and is arranged in bands that extend from the iris root and the ciliary body to the peripheral cornea. The corneoscleral meshwork consists of sheets of trabeculum that extend from the scleral spur to the lateral wall of the scleral sulcus. The juxtacanalicular meshwork, which is thought to be the major site of outflow resistance, is adjacent to, and actually forms the inner wall of, Schlemm's canal.
Episclera and sclera Dilation of the episcleral vessels may indicate elevated episcleral venous pressure, a finding that can be seen in the secondary glaucomas associated with Sturge- Weber syndrome, arteriovenous fistulae, or thyroid-associated orbitopathy. Sentinel vessels may be seen in eyes harboring an intraocular tumor. Any thinning or staphylomatous areas should be noted. 36 . Glaucoma Cornea Enlargement of the cornea associated with breaks in Oescemet's membrane (Haab striae) is commonly found in developmental glaucoma patients.
The Posner, Sussman, and Zeiss 4-mirror goniolenses allow all 4 quadrants of the chamber angle to be visualized without rotation of the lens during examination. They have a smaller area of contact than the Goldmann-type lens and about the same radius of curvature as the cornea, thus they are optically coupled by the patient's tears. Pressure on the cornea may distort the chamber angle. The examiner can detect this pressure by noting the induced Oescemet's membrane folds. Although pressure may falsely open the angle, the technique of dynamic gonioscopy is sometimes essential for distinguishing iridocorneal apposition from synechial closure.
2008-2009 Basic and Clinical Science Course: Section 10: Glaucoma (Basic and Clinical Science Course 2008-2009) by George A. Cioffi, MD