0
THE GLAUCOMAS 1 Dr Russell J Watkins
Anterior Chamber Anatomy <ul><li>Chamber volume is about 200  l </li></ul><ul><li>Chamber depth is about 3.2mm </li></ul>...
Anterior Chamber Anatomy <ul><li>Canal of Schlemm is oval in cross-section (200-400  m) </li></ul><ul><li>Canal is lined ...
Anterior Chamber Anatomy <ul><li>With age, there is </li></ul><ul><ul><li>2-3 fold thickening of trabecular sheets </li></...
 
 
 
Autonomic Control of Aqueous Secretion <ul><li>Cholinergic mechanisms probably not involved in control of IOP </li></ul><u...
Aqueous Humour Drainage <ul><li>~90% aqueous leaves eye via trabecular meshwork </li></ul><ul><li>~10% leaves eye via “unc...
Aqueous Outflow
 
Classification <ul><li>All forms of glaucoma are classified into primary & secondary forms based on </li></ul><ul><ul><li>...
Classification <ul><li>Associated conditions </li></ul><ul><ul><li>Ocular </li></ul></ul><ul><ul><li>Extraocular </li></ul...
Glaucoma Classification <ul><li>Primary Congenital Forms </li></ul><ul><ul><li>Primary Congenital Glaucoma </li></ul></ul>...
Glaucoma Classification <ul><li>Primary Open Angle Glaucomas </li></ul><ul><ul><li>Primary juvenile glaucoma </li></ul></u...
Glaucoma Classification <ul><li>Secondary Open Angle Glaucoma </li></ul><ul><ul><li>Pseudoexfoliation glaucoma </li></ul><...
 
Glaucoma Classification <ul><li>Primary Angle Closure Glaucomas </li></ul><ul><ul><li>Pupillary block mechanism </li></ul>...
 
Glaucoma Classification <ul><li>Secondary Angle Closure Glaucomas </li></ul><ul><ul><li>Secondary ACG with pupil block </l...
 
 
Primary Congenital Forms <ul><li>Primary congenital glaucoma </li></ul><ul><ul><li>Aetiology is angle dysgenesis </li></ul...
Primary Congenital Forms <ul><li>Primary congenital glaucoma (cont.) </li></ul><ul><ul><li>Photophobia, tearing, blepharos...
Primary Congenital Forms <ul><li>Primary infantile glaucoma  </li></ul><ul><ul><li>Probably late onset congenital glaucoma...
Primary Congenital Forms <ul><li>Glaucoma associated with congenital anomalies </li></ul><ul><ul><li>Aniridia </li></ul></...
 
 
 
 
 
 
Upcoming SlideShare
Loading in...5
×

THE GLAUCOMAS 1

3,610

Published on

Published in: Health & Medicine
0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
3,610
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
270
Comments
0
Likes
3
Embeds 0
No embeds

No notes for slide

Transcript of "THE GLAUCOMAS 1"

  1. 1. THE GLAUCOMAS 1 Dr Russell J Watkins
  2. 2. Anterior Chamber Anatomy <ul><li>Chamber volume is about 200  l </li></ul><ul><li>Chamber depth is about 3.2mm </li></ul><ul><ul><li>Deeper in myopes </li></ul></ul><ul><ul><li>Shallows with age </li></ul></ul><ul><li>Schwalbe’s line marks end of DM </li></ul><ul><li>Scleral spur receives insertion of the longitudonal ciliary fibres - contraction opens TM spaces </li></ul><ul><li>TM lined by trabeculocytes which have contractile properties which may influence outflow resistance </li></ul>
  3. 3. Anterior Chamber Anatomy <ul><li>Canal of Schlemm is oval in cross-section (200-400  m) </li></ul><ul><li>Canal is lined by endothelial cells which on inner wall have giant vacuoles </li></ul><ul><ul><li>Number & size of vacuoles varies with IOP </li></ul></ul><ul><li>This is the mechanism of the bulk transfer of aqueous to Canal of Schlemm </li></ul>
  4. 4. Anterior Chamber Anatomy <ul><li>With age, there is </li></ul><ul><ul><li>2-3 fold thickening of trabecular sheets </li></ul></ul><ul><ul><li>Loss of endothelial cellularity </li></ul></ul><ul><ul><li>Increase in connective tissue </li></ul></ul><ul><ul><li>Increased accumulation of TM debris </li></ul></ul><ul><ul><li>Increased accumulation of GAGs </li></ul></ul><ul><li>Such changes are exaggerated in OAG </li></ul>
  5. 8. Autonomic Control of Aqueous Secretion <ul><li>Cholinergic mechanisms probably not involved in control of IOP </li></ul><ul><li>Adrenergic (  1 ,  1  2 , &  2 ) receptors do regulate IOP </li></ul><ul><ul><li> receptor stimulation inhibits AC (  IOP) </li></ul></ul><ul><ul><ul><li> aqueous production </li></ul></ul></ul><ul><ul><ul><li> PGF 2  </li></ul></ul></ul><ul><ul><li> receptor stimulation activates AC (  IOP) </li></ul></ul><ul><ul><ul><li> aqueous production </li></ul></ul></ul>
  6. 9. Aqueous Humour Drainage <ul><li>~90% aqueous leaves eye via trabecular meshwork </li></ul><ul><li>~10% leaves eye via “unconventional” routes </li></ul><ul><ul><li>most important = “uveoscleral” </li></ul></ul><ul><li>Trabecular meshwork modulated by GAGs & Ca 2+ in ECM </li></ul><ul><li>Inner wall endothelium of Schlemm’s canal provides most of TM resistance to outflow </li></ul><ul><li>Intrascleral & episcleral venous flow also provides resistance to outflow </li></ul>
  7. 10. Aqueous Outflow
  8. 12. Classification <ul><li>All forms of glaucoma are classified into primary & secondary forms based on </li></ul><ul><ul><li>Gonioscopic findings </li></ul></ul><ul><ul><li>ONH findings </li></ul></ul><ul><ul><li>VF defects </li></ul></ul><ul><li>Major risk factors </li></ul><ul><ul><li>IOP (the major risk factor but not the whole story) </li></ul></ul><ul><ul><li>Vascular risk factors </li></ul></ul><ul><ul><ul><li>Local </li></ul></ul></ul><ul><ul><ul><li>Systemic </li></ul></ul></ul><ul><ul><li>Race </li></ul></ul>
  9. 13. Classification <ul><li>Associated conditions </li></ul><ul><ul><li>Ocular </li></ul></ul><ul><ul><li>Extraocular </li></ul></ul><ul><li>Additional useful clinical data </li></ul><ul><ul><li>BP, pulse, blood glucose, blood lipids </li></ul></ul><ul><ul><li>Migraine, cold hands/Raynaud’s </li></ul></ul><ul><ul><li>Thyroid disease, neurological diseases </li></ul></ul><ul><ul><li>History of blood loss, smoking </li></ul></ul><ul><ul><li>FOH +ve for visual loss </li></ul></ul><ul><ul><li>FOH +ve for glaucoma </li></ul></ul>
  10. 14. Glaucoma Classification <ul><li>Primary Congenital Forms </li></ul><ul><ul><li>Primary Congenital Glaucoma </li></ul></ul><ul><ul><li>Primary Infantile Glaucoma </li></ul></ul><ul><ul><li>Glaucoma associated with congenital anomalies </li></ul></ul>
  11. 15. Glaucoma Classification <ul><li>Primary Open Angle Glaucomas </li></ul><ul><ul><li>Primary juvenile glaucoma </li></ul></ul><ul><ul><li>Primary open angle glaucoma </li></ul></ul><ul><ul><li>Normal tension glaucoma </li></ul></ul><ul><ul><li>Ocular hypertension </li></ul></ul>
  12. 16. Glaucoma Classification <ul><li>Secondary Open Angle Glaucoma </li></ul><ul><ul><li>Pseudoexfoliation glaucoma </li></ul></ul><ul><ul><li>Pigmentary glaucoma </li></ul></ul><ul><ul><li>Lens-induced OAG </li></ul></ul><ul><ul><li>Glaucoma associated with intraocular haemorrhage </li></ul></ul><ul><ul><li>Uveitic glaucoma </li></ul></ul><ul><ul><li>et al ++ </li></ul></ul>
  13. 18. Glaucoma Classification <ul><li>Primary Angle Closure Glaucomas </li></ul><ul><ul><li>Pupillary block mechanism </li></ul></ul><ul><ul><li>Plateau iris mechanism </li></ul></ul><ul><ul><li>Malignant glaucoma </li></ul></ul><ul><ul><li>Chronic ACG </li></ul></ul>
  14. 20. Glaucoma Classification <ul><li>Secondary Angle Closure Glaucomas </li></ul><ul><ul><li>Secondary ACG with pupil block </li></ul></ul><ul><ul><li>Secondary ACG due to “pulling” of AC </li></ul></ul><ul><ul><ul><li>NVG </li></ul></ul></ul><ul><ul><ul><li>Aniridia </li></ul></ul></ul><ul><ul><ul><li>Inflammatory membrane </li></ul></ul></ul><ul><ul><ul><li>et al++ </li></ul></ul></ul>
  15. 23. Primary Congenital Forms <ul><li>Primary congenital glaucoma </li></ul><ul><ul><li>Aetiology is angle dysgenesis </li></ul></ul><ul><ul><li>Pathomechanism is  aqueous outflow </li></ul></ul><ul><ul><li>Onset from birth to second year of life </li></ul></ul><ul><ul><li>Usually sporadic; 10% may be AR with variable penetrance; specific chromosomal abnormalities (1p36 & 2q21) </li></ul></ul><ul><ul><li>1 in 10,000 live births </li></ul></ul><ul><ul><li>M>F (65%:35%) </li></ul></ul>
  16. 24. Primary Congenital Forms <ul><li>Primary congenital glaucoma (cont.) </li></ul><ul><ul><li>Photophobia, tearing, blepharospasm </li></ul></ul><ul><ul><li>Eye rubbing, EUA for IOP unreliable </li></ul></ul><ul><ul><li>Buphthalmos (cornea  >11mm) </li></ul></ul><ul><ul><li>Corneal oedema (±ruptures in DM  Haab’s striae) </li></ul></ul><ul><ul><li>ONH: pressure distension/uniform enlargement </li></ul></ul><ul><ul><li>VCDR>0.3 </li></ul></ul><ul><ul><li>Gonio: open angle but poorly differentiated structures; trabeculodysgenesis; anterior iris insertion </li></ul></ul>
  17. 25. Primary Congenital Forms <ul><li>Primary infantile glaucoma </li></ul><ul><ul><li>Probably late onset congenital glaucoma </li></ul></ul><ul><ul><li>Same aetiology & pathomechanism as PCG </li></ul></ul><ul><ul><li>Onset 3rd to tenth yr of life </li></ul></ul><ul><ul><li>Similar genetics to PCG </li></ul></ul><ul><ul><li>Pain unusual; no buphthalmos or corneal oedema </li></ul></ul><ul><ul><li>Often presents late with symptomatic VF loss </li></ul></ul><ul><ul><li>Peak IOP > 24mmHg without Rx </li></ul></ul><ul><ul><li>ONH shows pressure distension & generalised cup enlargement with diffuse rim damage </li></ul></ul><ul><ul><li>Gonio as PCG </li></ul></ul>
  18. 26. Primary Congenital Forms <ul><li>Glaucoma associated with congenital anomalies </li></ul><ul><ul><li>Aniridia </li></ul></ul><ul><ul><li>Sturge Weber syndrome </li></ul></ul><ul><ul><li>Neurofibromatosis </li></ul></ul><ul><ul><li>Marfan syndrome </li></ul></ul><ul><ul><li>Homocystinuria </li></ul></ul><ul><ul><li>Goniodysgenesis </li></ul></ul><ul><ul><ul><li>Axenfeld-Rieger syndrome & Peter’s anomaly </li></ul></ul></ul><ul><ul><li>Rubella </li></ul></ul><ul><ul><li>Microcornea </li></ul></ul><ul><ul><li>PHPV </li></ul></ul><ul><ul><li>et al. </li></ul></ul>
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×