glaucoma：青光眼

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1、GlaucomaGlaucomaAnopticneuropathycharacterizedby:ElevatedintraocularpressureOpticdiskcuppingVisualfieldlossNormalvisualfieldShrinkingvisionAdvancedfieldlossTunnelvisionRaisedintraocularpressureImpairedoutflowofaqueousresultingfrom:abnormalitieswithinthedrainagesystemoftheanteri

2、orchamberangle(i.e.open-angleglaucoma)Impairedaccessofaqueoustothedrainagesystem(i.e.closedangleglaucoma)PhysiologyoftheAqueousHumorClearliquidthatfillsanteriorandposteriorchambersoftheeyeUltrafiltrateofplasmaproducedinthestromaoftheciliaryprocessVolume:250uL,2.5uL/minOsmoticpr

3、essure:slightlyhigherthanplasmaComposition:likeplasmabuthigherconcentrationofascorbate,pyruvateandlactate&lowerconcentrationofprotein,urea,andglucoseAqueousformationandflowCiliarybodyPosteriorchamberPupilAnteriorchamberTrabecularmeshworkSchlemm’scanalPathophysiologyGanglioncell

4、atrophy-Majormechanismofvisuallossinglaucoma-LeadstothinningoftheinnernuclearandnervelayersoftheretinaandaxonallossintheopticnerveOpticdiskbecomesatrophic,withenlargementoftheopticcupIrisandciliarybodyalsobecomeatrophicandtheciliaryprocessesshowhyalinedegenerationRiskFactorsfor

5、developingGlaucomaAge(>40yearsold)Females>MalesHyperope(+)FamilyhistoryofglaucomaGIC1a(myocillingene)inopenangleglSystemicdisease:HPN,DMTraumaUnderlyingocularconditions:ex.CRAO,phacolytic,uveitisDrugs,ex.steroidsClinicalAssessmentFundoscopy/OpticDiscAssessmentTonometryGonioscop

6、yVisualFieldEvaluationOpticDiskAssessmentPhysiologicCupNormalcentraldepressionSizedependsonthebulkofthefibersthatformtheopticnerverelativetothesizeofthescleralopeningHyperopiceyes–scleralopeningissmall->smallopticcupOpticDiskAssessmentGlaucomatousopticatrophyLossofdiscsubstance

7、;enlargementofopticdisccupDiscpallorintheareaofcuppingConcentricenlargementoftheopticcuporpreferentialsuperiorandinferiorcuppingwithfocalnotchingoftherimoftheopticdiscRetinalvesselsondiscaredisplacednasally“beanpotcup”Cup-discratio:ratioofcupsizetodiscdiameter(>0.5orsignificant

8、asymmetrybetweenthetwoeyes)Atrophyofnervefiberlayer(Ho