Download 2008-2009 Basic and Clinical Science Course: Section 10: by George A. Cioffi, MD PDF

By George A. Cioffi, MD

This part underwent significant revision for the 2008-2009 edition.Topics mentioned contain the epidemiologic elements of glaucoma; hereditary and genetic elements; intraocular strain and aqueous humor dynamics; medical review; scientific administration of and surgical remedy for glaucoma. This variation comprises up to date tables and revised photos, in addition to a variety of new pictures illustrating either disorder entities and surgical ideas.

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Extra resources for 2008-2009 Basic and Clinical Science Course: Section 10: Glaucoma (Basic and Clinical Science Course 2008-2009)

Example text

With dynamic gonioscopy (compression or indentation gonioscopy), gentle pressure is placed on the cornea, and aqueous humor is forced into the chamber angle (see Fig 3-3). The posterior diameter of these goniolenses is smaller than the corneal diameter, and posterior pressure can be used to force open a narrowed angle. In inexperienced hands, dynamic gonioscopy may be misleading, as undue pressure on the anterior surface of the cornea may distort the chamber angle or may give the observer the false impression of an open angle.

An example of an association between adnexal changes and systemic disease is tuberous sclerosis (Bourneville syndrome), in which glaucoma may occur secondary to vitreous hemorrhage, anterior segment neovascularization, or retinal detachment. Typical external and cutaneous signs of tuberous sclerosis include a hypopigmented lesion termed the "ash-leaf sign" and a red-brown papular rash (adenoma sebaceum) that is often found on the face and chin. Glaucoma is commonly associated with neurofibromatosis (von Recklinghausen disease), likely secondary to developmental abnormalities of the anterior chamber angle.

The relationship between secretion and ultrafiltration is not known. Diffusion is the passive movement of ions across a membrane related to charge and concentration. In humans, aqueous humor has an excess of hydrogen and chloride ions, an excess of ascorbate, and a deficit of bicarbonate relative to plasma. Aqueous humor is essentially protein free (1/200-1/500 of the protein found in plasma), which allows for optical clarity and reflects the integrity of the blood-aqueous barrier of the normal eye.

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