By George A. Cioffi, MD
This part underwent significant revision for the 2008-2009 edition.Topics mentioned comprise the epidemiologic facets of glaucoma; hereditary and genetic components; intraocular strain and aqueous humor dynamics; scientific overview; clinical administration of and surgical treatment for glaucoma. This variation includes up-to-date tables and revised photographs, in addition to quite a few new pictures illustrating either illness entities and surgical thoughts.
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Extra info for 2008-2009 Basic and Clinical Science Course: Section 10: Glaucoma (Basic and Clinical Science Course 2008-2009)
Exfoliation syndrome may appear clinically similar to pigment dispersion syndrome, with pigment granules on the anterior surface of the iris, increased pigment in the anterior chamber angle, and secondary open-angle glaucoma. Pigmentation of the angle structures is usually patchy in exfoliation syndrome, as compared with the more uniform pigment distribution seen in pigment dispersion syndrome. In addition, a line of pigment deposition anterior to the Schwalbe line is often present in exfoliation syndrome (Sampaolesi line).
The rate of aqueous formation is affected by a variety of factors, including . integrity of the blood-aqueous barrier blood flow to the ciliary body neurohumoral regulation of vascular tissue and the ciliary epithelium . Aqueous humor production may decrease following trauma or intraocular inflammation and following the administration of certain drugs, such as general anesthetics and some systemic hypotensive agents. Carotid occlusive disease may also decrease aqueous humor production. Aqueous Humor Outflow Aqueous humor outflow occurs by 2 major mechanisms: pressure-dependent outflow and pressure-independent outflow.
Gonioscopy with a Zeiss lens with indentation shows peripheral anterior synechiae in the posterior trabecular meshwork. Pigment deposits on the Schwalbe line can also be seen. This is the same angle as shown in C. (Courtesvof Elizabeth A. Hodapp, MD.! 38 . Glaucoma Table 3-' Gonioscopic Examination Tissue Features Posterior cornea Schwalbe line Trabecular meshwork Pigmentation, guttae, corneal endothelium Thickening, anterior displacement Pigmentation, peripheral anterior synechiae (PAS), inflammatory or neovascular membranes, keratic precipitates Iris processes, presence or absence Width, regularity, cyclodialysis cleft Contour, rubeosis, atrophy, cysts, iridodonesis Exfoliation syndrome, posterior synechiae, position and regularity, sphincter rupture, ectropion uveae Pigmentation, rupture Scleral spur Ciliary body band Iris Pupil and lens Zonular fibers magnification.