By George A. Cioffi, MD
This part underwent significant revision for the 2008-2009 edition.Topics mentioned comprise the epidemiologic elements of glaucoma; hereditary and genetic components; intraocular strain and aqueous humor dynamics; medical overview; clinical administration of and surgical treatment for glaucoma. This variation includes up to date tables and revised pictures, in addition to various new photographs illustrating either sickness entities and surgical suggestions.
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Extra info for 2008-2009 Basic and Clinical Science Course: Section 10: Glaucoma (Basic and Clinical Science Course 2008-2009)
Cantor, Pigmentation MD,) of the trabecular meshwork increases with age and tends to be more marked in individuals with darkly pigmented irides. Pigmentation can be segmental and is usually most marked in the inferior angle. The pigmentation pattern of an individual angle is dynamic over time, especially in conditions such as pigment dispersion syndrome. Heavy pigmentation of the trabecular meshwork should suggest pigment dispersion or exfoliation syndrome. Exfoliation syndrome may appear clinically similar to pigment dispersion syndrome, with pigment granules on the anterior surface of the iris, increased pigment in the anterior chamber angle, and secondary open-angle glaucoma.
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.
Glaucomas associated with other anterior segment anomalies are described in the following discussions. Punctate epithelial defects, especially in the inferonasal interpalpebral region, are often indicative of medication toxicity. Microcystic epithelial edema is commonly associated with elevated lOP, particularly when the lOP rise is acute. Corneal endothelial abnormalities, such as the following, can be important clues to the presence of an underlying associated secondary glaucoma: . Krukenberg spindle in pigmentary glaucoma .