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Файл:Ординатура / Офтальмология / Учебные материалы / Clinical Anatomy and Physiology of the Visual System 2012.pdf
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- •Preface
- •Acknowledgments
- •Anatomic Features
- •Anatomic Directions and Planes
- •Refractive Conditions
- •Epithelial Tissue
- •Glandular Epithelium
- •Connective Tissue
- •Muscle Tissue
- •Nerve Tissue
- •Intercellular Junctions
- •References
- •Cornea
- •Corneal Dimensions
- •Corneal Histologic Features
- •Epithelium
- •Epithelial Replacement
- •Bowman’s Layer
- •Stroma or Substantia Propria
- •Descemet’s Membrane
- •Endothelium
- •Corneal Function
- •Corneal Hydration
- •Aquaporins
- •Corneal Metabolism
- •Corneal Repair: Wound Healing
- •Epithelium
- •Bowman’s
- •Stroma
- •Descemet’s
- •Endothelium
- •Absorption of Ultraviolet Radiation (UVR)
- •Corneal Innervation
- •Corneal Blood Supply
- •Sclera
- •Scleral Histologic Features
- •Episclera
- •Sclera
- •Physiology of Scleral Changes in Myopia
- •Scleral Spur
- •Scleral Opacity
- •Scleral Color
- •Scleral Foramina And Canals
- •Scleral Blood Supply
- •Scleral Innervation
- •Limbal Histologic Features
- •Palisades of Vogt
- •References
- •IRIS
- •Histologic Features of Iris
- •Anterior Border Layer
- •Iris Stroma and Sphincter Muscle
- •Anterior Epithelium and Dilator Muscle
- •Posterior Epithelium
- •Anterior Iris Surface
- •Posterior Iris Surface
- •Iris Color
- •CILIARY BODY
- •Supraciliaris (Supraciliary Lamina)
- •Ciliary Muscle
- •Ciliary Stroma
- •Ciliary Epithelium
- •Choroid
- •Suprachoroid Lamina (Lamina Fusca)
- •Choroidal Stroma
- •Choriocapillaris
- •Functions of Iris
- •Functions of Ciliary Body
- •Aqueous Production
- •Function and Rate of Production
- •Vitreous Production
- •Blood-Aqueous Barrier
- •Functions of Choroid
- •Iris
- •Ciliary Body
- •Choroid
- •References
- •Retinal Pigment Epithelium
- •Photoreceptor Cells
- •Composition of Rods and Cones
- •Outer Segment
- •Cilium
- •Inner Segment
- •Outer Fiber, Cell Body, and Inner Fiber
- •Rod and Cone Morphology
- •Rods
- •Cones
- •Bipolar Cells
- •Ganglion Cells
- •Horizontal Cells
- •Amacrine Cells
- •Interplexiform Neurons
- •Neuroglial Cells
- •Müller Cells
- •Microglial Cells and Astrocytes
- •Retinal Pigment Epithelium
- •Photoreceptor Layer
- •External Limiting Membrane
- •Outer Nuclear Layer
- •Outer Plexiform Layer
- •Inner Nuclear Layer
- •Inner Plexiform Layer
- •Ganglion Cell Layer
- •Nerve Fiber Layer
- •Internal Limiting Membrane
- •Physiology of the rpe
- •Scotopic and Photopic Vision
- •Neural Signals
- •Number and Distribution of Neural Cells
- •Physiology of the neural retina
- •Retinal Synapses
- •Neurotransmitters
- •Phototransduction
- •Information Processing
- •Receptive Fields
- •Light and Dark Adaptation
- •Circadian Rhythm
- •Retinal Metabolism
- •Central Retina
- •Macula Lutea
- •Fovea (Fovea Centralis)
- •Foveola
- •Parafoveal and Perifoveal Areas
- •Peripheral Retina
- •Optic Disc
- •Blood-Retinal Barrier
- •References
- •Lens Capsule
- •Lens Epithelium
- •Lens Fibers
- •Epithelium-Fiber Interface
- •Lens Capsule
- •LENS Fibers
- •Fiber Components
- •Formation of Lens Fibers
- •Fiber Junctions
- •Lens Metabolism
- •Ionic Current
- •Regulation of Fluid Volume
- •Oxidative Stress
- •Cataracts
- •The Physiology of Cataract Formation
- •Age-Related Cortical Cataract
- •Age-Related Nuclear Cataract
- •Posterior Subcapsular Cataract (PSC)
- •Steroid-Induced Cataract
- •References
- •Scleral Spur
- •Trabecular Meshwork
- •Canal of Schlemm
- •Juxtacanalicular Connective Tissue
- •Function of the Filtration Apparatus
- •Posterior Chamber
- •FACTORS AFFECTING Intraocular Pressure
- •Drugs that Effect IOP
- •Vitreous Chamber
- •Vitreal Attachments
- •Vitreous Zones
- •Vitreous Cortex
- •Intermediate Zone
- •Cloquet’s Canal
- •Composition of Vitreous
- •Collagen
- •Hyaluronic Acid (hyaluronan)
- •Hyalocytes
- •Vitreal Function
- •Age-Related Vitreal Changes
- •References
- •Optic Pits
- •Optic Cup, Lens, and hyaloid vessels
- •Optic Cup
- •Lens
- •Hyaloid Arterial System
- •Retinal Pigment Epithelium
- •Neural Retina
- •Retinal Vessels
- •Cornea
- •Sclera
- •UVEA
- •Choroid
- •Ciliary Body
- •Iris
- •Pupillary Membrane
- •Anterior Chamber
- •Vitreous
- •Optic Nerve
- •Eyelids
- •Orbit
- •Extraocular Muscles
- •Nasolacrimal System
- •References
- •Orbital Walls
- •Roof
- •Floor
- •Medial Wall
- •Lateral Wall
- •Orbital Margins
- •Orbital Foramina and Fissures
- •Paranasal Sinuses
- •ORBITAL CONNECTIVE TISSUE
- •Periorbita
- •Orbital Septum
- •Tenon’s Capsule
- •Suspensory Ligament (of Lockwood)
- •Orbital Muscle of Müller
- •Orbital Septal System
- •Orbital Fat
- •Aging Changes in the Orbit
- •References
- •Palpebral Fissure
- •Eyelid Topography
- •Eyelid Margin
- •Eyelid Structures
- •Orbicularis Oculi Muscle
- •Palpebral Portion
- •Orbital Portion
- •Orbicularis Action
- •Superior Palpebral Levator Muscle
- •Levator Aponeurosis
- •Levator Action
- •Retractor of Lower Eyelid
- •Tarsal Muscle (of Müller)
- •Tarsal Plate
- •Palpebral Ligaments
- •Glands of the Lids
- •Histologic Features
- •Skin
- •Muscles
- •Tarsal Plates
- •Palpebral Conjunctiva
- •Glands
- •Innervation of Eyelids
- •Blood Supply of Eyelids
- •Conjunctiva
- •Plica Semilunaris
- •Caruncle
- •Conjunctival Blood Vessels
- •Conjunctival Lymphatics
- •Conjunctival Innervation
- •Lacrimal Secretory System
- •Tear Film Distribution
- •Nasolacrimal Drainage System
- •Puncta and Canaliculi
- •Lacrimal Sac and Nasolacrimal Duct
- •Tear Drainage
- •References
- •Sliding Ratchet Model of Muscle Contraction
- •Structure of the Extraocular Muscles
- •Fick’s Axes
- •Ductions
- •Vergences and Versions
- •Positions of Gaze
- •Origin of the Rectus Muscles
- •Insertions of the Rectus Muscles: Spiral of Tillaux
- •Medial Rectus Muscle
- •Lateral Rectus Muscle
- •Superior Rectus Muscle
- •Inferior Rectus Muscle
- •Superior Oblique Muscle
- •Inferior Oblique Muscle
- •FIBERS OF THE Extraocular muscleS
- •ORBITAL CONNECTIVE TISSUE STRUCTURES
- •Horizontal Rectus Muscles
- •Vertical Rectus Muscles
- •Oblique Muscles
- •Movements From Secondary Positions
- •Vertical Rectus Muscles
- •Oblique Muscles
- •Yoke Muscles
- •Innervation
- •Blood Supply
- •References
- •Ophthalmic Artery
- •Central Retinal Artery
- •Lacrimal Artery
- •Posterior Ciliary Arteries
- •Ethmoid Arteries
- •Supraorbital Artery
- •Muscular Arteries
- •Anterior Ciliary Arteries
- •Medial Palpebral Arteries
- •Supratrochlear Artery
- •Dorsonasal Artery
- •Facial Artery
- •Superficial Temporal Artery
- •Maxillary Artery
- •Superior Ophthalmic Vein
- •Central Retinal Vein
- •Vortex Veins
- •Inferior Ophthalmic Vein
- •Anterior Ciliary Veins
- •Infraorbital Vein
- •Cavernous Sinus
- •References
- •Trigeminal Nerve
- •Ophthalmic Division of Trigeminal Nerve
- •Nasociliary Nerve
- •Frontal Nerve
- •Lacrimal Nerve
- •Ophthalmic Nerve Formation
- •Maxillary Division of Trigeminal Nerve
- •Infraorbital Nerve
- •Zygomatic Nerve
- •Maxillary Nerve Formation
- •Trigeminal Nerve Formation
- •Oculomotor Nerve: Cranial Nerve III
- •Oculomotor Nucleus
- •Oculomotor Nerve Pathway
- •Trochlear Nerve: Cranial Nerve IV
- •Trochlear Nucleus
- •Trochlear Nerve Pathway
- •Abducens Nucleus
- •Abducens Nerve Pathway
- •Superior Orbital Fissure
- •Control of Eye Movements
- •Facial Nerve: Cranial Nerve VII
- •Facial Nucleus
- •Facial Nerve Pathway
- •References
- •Optic Nerve
- •Optic Chiasm
- •Optic Tract
- •Lateral Geniculate Nucleus
- •Optic Radiations (Geniculocalcarine Tract)
- •Primary Visual Cortex (Striate Cortex)
- •Retina
- •Optic Disc
- •Optic Nerve
- •Optic Chiasm
- •Optic Tract
- •Lateral Geniculate Nucleus
- •Optic Radiations
- •Striate Cortex
- •Striate Cortex Maps
- •Macular Sparing
- •References
- •Sympathetic Pathway to Ocular Structures
- •Parasympathetic Pathway to Ocular Structures
- •Neurotransmitters
- •Ophthalmic Agonist Agents
- •Ophthalmic Antagonist Agents
- •Disruption in the Afferent Pathway
- •Disruption within the Central Nervous System
- •Disruption in the Efferent Pathway
- •Disruption in the Sympathetic Pathway
- •References
- •Index
22 Clinical Anatomy of the Visual System
A
B
FIGURE 2-15
Endothelial integrity can be evaluated by determining the coefficient of variation (CV) of cell size. Normal endothelium has a CV of 0.25. A, Endothelium of healthy 25-year-old non-contact lens wearer. Endothelial cell density is 2000 cells/mm2, hexagonality is 69%, and CV is 0.25. B, Endothelium of 40-year-old patient who has worn polymethyl methacrylate contact lenses for 23 years. Endothelial cell density is 1676 cells/mm2, hexagonality is 24%, and CV is 0.66. (A courtesy Scott MacRae, M.D., Oregon Health Sciences University, Portland, Ore.; B from MacRae SM, Matsuda M, Shellans S et al: The effects of hard and soft contact lenses on the corneal endothelium, Am J Ophthalmol 102:50, 1986.)
called corneal crystallins, and they share many of the attributes of the long recognized lens crystallins, important in maintaining the transparency of the lens.77
Because the stroma makes up 90% of the cornea, the regularity of spacing between the collagen fibrils is important in maintaining corneal transparency. The negatively charged molecules located around each collagen fibril maintain this precise arrangement by their
bonds with water molecules, and corneal transparency is optimal when the stroma is 75% to 80% water.4,78
Corneal Hydration
This relative corneal deturgescence (78% water content) requires precise control of stromal extracellular water content and is dependent upon: (1) the barrier
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