青光眼课件_2

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1、GlaucomaGlaucomaAnopticneuropathycharacterizedby:ElevatedintraocularpressureOpticdiskcuppingVisualfieldlossNormalvisualfieldShrinkingvisionAdvancedfieldlossTunnelvisionRaisedintraocularpressureImpairedoutflowofaqueousresultingfrom:abnormalitieswithin

2、thedrainagesystemoftheanteriorchamberangle(i.e.open-angleglaucoma)Impairedaccessofaqueoustothedrainagesystem(i.e.closedangleglaucoma)PhysiologyoftheAqueousHumorClearliquidthatfillsanteriorandposteriorchambersoftheeyeUltrafiltrateofplasmaproducedinthe

3、stromaoftheciliaryprocessVolume:250uL,2.5uL/minOsmoticpressure:slightlyhigherthanplasmaComposition:likeplasmabuthigherconcentrationofascorbate,pyruvateandlactate&lowerconcentrationofprotein,urea,andglucoseAqueousformationandflowCiliarybodyPosteriorch

4、amberPupilAnteriorchamberTrabecularmeshworkSchlemm’scanalPathophysiologyGanglioncellatrophy-Majormechanismofvisuallossinglaucoma-LeadstothinningoftheinnernuclearandnervelayersoftheretinaandaxonallossintheopticnerveOpticdiskbecomesatrophic,withenlarge

5、mentoftheopticcupIrisandciliarybodyalsobecomeatrophicandtheciliaryprocessesshowhyalinedegenerationRiskFactorsfordevelopingGlaucomaAge(>40yearsold)Females>MalesHyperope(+)FamilyhistoryofglaucomaGIC1a(myocillingene)inopenangleglSystemicdisease:HPN,DMTr

6、aumaUnderlyingocularconditions:ex.CRAO,phacolytic,uveitisDrugs,ex.steroidsClinicalAssessmentFundoscopy/OpticDiscAssessmentTonometryGonioscopyVisualFieldEvaluationOpticDiskAssessmentPhysiologicCupNormalcentraldepressionSizedependsonthebulkofthefiberst

7、hatformtheopticnerverelativetothesizeofthescleralopeningHyperopiceyes–scleralopeningissmall->smallopticcupOpticDiskAssessmentGlaucomatousopticatrophyLossofdiscsubstance;enlargementofopticdisccupDiscpallorintheareaofcuppingConcentricenlargementoftheop

8、ticcuporpreferentialsuperiorandinferiorcuppingwithfocalnotchingoftherimoftheopticdiscRetinalvesselsondiscaredisplacednasally“beanpotcup”Cup-discratio:ratioofcupsizetodiscdiameter(>0.5orsignificantasymmetrybetweenthetwoeyes)Atrophyofnervefiberlayer(Ho