Ординатура / Офтальмология / Английские материалы / Illustrated Tutorials in Ophthalmology Kanski, Bolton 2001
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Treatment Options for Ectopia Lentis
1.Spectacle correction
•For induced astigmatism
•For aphakic portion
2.Nd:YAG laser zonulysis to displace lens out of visual axis
3.Surgical removal
•Associated cataract
•Lens-induced glaucoma
•Endothelial touch
•When other methods are inappropriate
INTRODUCTION TO GLAUCOMA
1.Aqueous outflow
•Anatomy
•Physiology
2.Classification of secondary glaucoma
3.Tonometers
4.Gonioscopy
5.Anatomy of retinal nerve fibres
6.Optic nerve head
7.Humphrey perimetry
Aqueous outflow
Anatomy |
Physiology |
a - Uveal meshwork |
a - Conventional outflow |
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b - Corneoscleral meshwork |
b - Uveoscleral outflow |
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c - Schwalbe line |
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c - Iris outflow |
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d - Schlemm canal |
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e - Collector channels |
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f - Longitudinal muscle of |
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ciliary body |
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g - Scleral spur |
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Classification of secondary glaucomas
a |
b |
Open-angle |
a.Pre-trabecular - membrane over trabeculum
b.Trabecular - ‘clogging up’ of trabeculum
c |
d |
Angle-closure |
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c. With pupil block - seclusio pupillae and |
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iris bombé |
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d. Without pupil block - peripheral anterior |
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synechiae |
Tonometers
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Goldmann |
Perkins |
Schiotz |
Contact applanation |
Portable contact applanation |
Contact indentation |
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Air-puff |
Pulsair 2000 (Keeler) |
Tono-Pen |
Non-contact indentation |
Portable non-contact applanation |
portable contact applanation |
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Goniolenses
Goldmann |
Zeiss |
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Single or triple mirror |
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Four mirror |
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Contact surface diameter 12 mm |
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Contact surface diameter 9 mm |
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Coupling substance required |
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Coupling substance not required |
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Suitable for ALT |
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Not suitable for ALT |
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Not suitable for indentation gonioscopy |
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Suitable for indentation gonioscopy |
Indentation gonioscopy
Differentiates ‘appositional’ from ‘synechial’ angle closure
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Press Zeiss lens posteriorly |
Aqueous is forced into |
against cornea |
periphery of anterior chamber |
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Indentation gonioscopy in iridocorneal contact
During indentation |
Before indentation |
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Part of angle is forced open |
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Complete angle closure |
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Part of angle remains closed by PAS |
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Apex of corneal wedge not visible |
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Angle structures
Schwalbe line
Trabeculum
Schlemm canal
Scleral spur
Iris processes
Shaffer grading of angle width
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Grade 4 (35-45 ) |
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Ciliary body easily visible |
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Grade 3 (25-35 ) |
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At least scleral spur visible |
3 |
2 |
1 |
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Grade 2 (20 ) |
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Only trabeculum visible |
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4 |
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0 |
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Angle closure possible but unlikely |
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Grade 1 (10 ) |
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Only Schwalbe line and perhaps |
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top of trabeculum visible |
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High risk of angle closure |
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Grade 0 (0 ) |
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Iridocorneal contact present |
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Apex of corneal wedge not visible |
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Use indentation gonioscopy |
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