2011-2012 Basic and Clinical Science Course, Section 10: by George A. Cioffi MD

By George A. Cioffi MD

Themes on glaucoma comprise the epidemiologic elements; hereditary and genetic components; intraocular strain and aqueous humor dynamics; and medical review, clinical administration and surgical remedy. comprises a number of photographs illustrating sickness entities and surgical ideas. final significant revision 2008 2009.

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Extra resources for 2011-2012 Basic and Clinical Science Course, Section 10: Glaucoma (Basic & Clinical Science Course)

Example text

The distribution of nerve fibe rs as they enter the optic nerve head is shown in Figure 3- J O. The arcuate nerve fibers enteri ng the superior and inferior poles of the disc seem to be more susceptible to glaucomatous damage. This susceptibility explains the frequent occurrence of arcuate nerve fiber bundle visual field defects in glaucoma. The arra ngement of the axons in the optic nerve head and their differential susceptibility to 48 • G la ucoma Re tin a Nerve Figure 3·10 Anatomy of retinal nerve fiber distribution.

Direct gonioscopy Indirect Dynamic Figure 3-3 Direct and indirect gonioscopy. Gonioscopic lenses eliminate the tear- air interface and total internal reflection. With a direct lens, the light ray reflected from the anterior chamber angle is observed directly, whereas with an indirect lens the li ght ray is reflected by a mirror within the lens. Posterior pressure with an indirect lens forces open an appositionaliy closed or narrow an- ter ior chamber angle (dynam ic gonioscopy). (Reprmted with permission from Wrighr KW, ed.

Angle closure is probable in time. Slit: The angle between the iris and the surface of the trabecula r meshwork is less than 10°. Angle closure is very likely. 0: The iris is agai nst the trabec ul ar meshwork. Angle closure is present. The Spaeth gonioscopic grading system expands this system to incl ude a description of the peripheral iris contour, the insertion of the iris root, and the effects of dynamic gonioscopy on the angle configuration (Fig 3-4) . Ordinarily, Schlemm's canal is invisible by gonioscopy.

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