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 elements; intraocular strain and aqueous humor dynamics; medical review; clinical administration of and surgical remedy for glaucoma. This variation comprises up to date tables and revised pictures, in addition to various new photographs illustrating either disorder entities and surgical recommendations.
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Additional resources for 2008-2009 Basic and Clinical Science Course: Section 10: Glaucoma (Basic and Clinical Science Course 2008-2009)
However, lOP has a nonGaussian distribution with a skew toward higher pressures, especially in individuals older than age 40 (Fig 2-3). The value 22 mm Hg (greater than 2 standard deviations above the mean) has been used in the past both to separate normal and abnormal pressures and to define which patients required ocular hypotensive therapy. This division was based on the erroneous clinical assumptions that glaucomatous damage is caused exclusively by pressures that are higher than normal and that normal pressures do not cause damage.
A "beaten bronze" appearance in the iridocorneal endothelial syndrome An anteriorly displaced Schwalbe line is found in Axenfeld-Rieger syndrome. The presence of traumatic or surgical corneal scars should be noted. The central corneal thickness (CCT) of all patients suspected of glaucoma should be assessed by corneal pachymetry because of the effect of CCT on the accuracy of applanation tonometry and its possible implication as a risk factor in some types of glaucomas. ) Anterior chamber To estimate the width of the chamber angle, the examiner directs a narrow slit beam at an angle of 60° onto the cornea just anterior to the limbus (Van Herick method).
The inferior portion of the angle is generally wider and is the easiest place in which to locate the landmarks. After verifying the landmarks, the clinician should examine the entire angle in an orderly manner (see Table 3-1). Proper management of glaucoma requires that the clinician determine not only whether the angle is open or closed, but also whether other pathologic findings, such as angle recession or low PAS, are present. In angle closure, the peripheral iris obstructs the trabecular meshwork-that is, the meshwork is not visible on gonioscopy.
2008-2009 Basic and Clinical Science Course: Section 10: Glaucoma (Basic and Clinical Science Course 2008-2009) by George A. Cioffi, MD