[临床医学]青光眼.ppt

Glaucoma (青光眼) 张纯 北京大学眼科中心 Glaucoma Introduction History Anatomy Aqueous humor cycle and IOP Definition of glaucoma Classification History 中国医学 《神农本草经》（秦汉）：青盲 《外台秘要》（唐）：黑盲、乌风、绿翳青盲 〈眼科龙木论〉（元）：绿风内障 《审视瑶函》（明） 〈医宗金鉴》（清） History 西方医学 Helmholtz (1852)：眼底镜 Von Graefe (1857)：青光眼视神经改变 Schiotz (1905)：眼压计 Machenzie (1930)：青光眼与高眼压 History 西方医学 解剖 解剖 解剖 视神经检查 Glaucoma Introduction History Anatomy Aqueous humor cycle and IOP Definition of glaucoma Classification Glaucoma Introduction History Anatomy Aqueous humor cycle and IOP Definition of glaucoma Classification 房水循环 Aqueous humor Formed by the ciliary epithelium, Passes between iris and lens to enter the anterior chamber Leaves the eye through the trabecular meshwork-Schlemm’s canal and choroid-scleral pathway Intraocular Pressure (IOP) IOP：眼球内容物作用于眼球内壁的压力 正常：11-21mmHg，双眼差小于5mmHg，单眼昼夜差小于8mmHg 高眼压症：眼压高于21mmHg，正常视神经 正常眼压性青光眼：眼压正常，视神经损害 青光眼：眼压高于21mmHg，视神经损害 Intraocular Pressure (IOP) IOP Rate of aqueous humor production at ciliary body Resistance to the outflow of aqueous humor at the angle of the anterior chamber Level of epi-scleral venous pressure Glaucoma Introduction History Anatomy Aqueous humor cycle and IOP Definition of glaucoma Classification Definition The word glaucoma originally meant “clouded” in Greek (mature cataract and corneal edema result from chronic IOP↑) A group of diseases share certain features including cupping and atrophy of the optic nerve head related to the level of IOP Textbook Glaucoma Introduction History Anatomy Aqueous humor cycle and IOP Definition of glaucoma Classification 青光眼的临床分类 原发性 闭角型 急性 慢性：虹膜膨隆和虹膜高褶 开角型：慢性单纯性和正常眼压性 继发性 先天性：婴幼儿型、青少年型和其他 混合性 附：国外分类 Angle-closure glaucoma (ACG) With pupillary block Primary (acute, subacute and chronic) Secondary Without pupillary block Primary Secondary (anterior or posterior mechanism) 附：国外分类 Open-angle glaucoma (OAG) Primary: IOP higher or “normal” Secondary Combined-mechanism Developmental: primary or secondary 青光眼的病生理 青光眼的病理-房角 青光眼的病理-角膜 青光眼的病理-巩