Medical control of the glaucomas.

Abstract

272call these cases of malignant glaucoma, using the old term in a new broader sense, or whether we devise a new terminology to describe such phenomena should perhaps await further experimentation. ConclusionMany questions still remain in regard to malignant glaucoma, and it is to be hoped that future observations will gradually elucidate them. Today, however, medical therapy consisting of the concurrent use of mydriatic-cycloplegic drops, carbonic anhydrase inhibitors, and hyperosmotic agents is available, and is proving to be effective in half the cases when continued for 5 days. In addition, the vitreous surgery described above is in our opinion a safe and reliable surgical procedure in cases of malignant glaucoma which are not relieved by medical therapy.Chandler's anterior chamber deepening procedure with gonioscopy used for diagnosis of the extent of synaechial closure of the angle does not seem to predispose to malignant glaucoma.Even though it is known that there is a predisposition to malignant glaucoma in the fellow eye, this eye should always be treated with a peripheral iridectomy as early as possible after the onset of malignant glaucoma in the opposite eye. No medical treatment of any sort should be given before the peripheral iridectomy, since both miotics and mydriatics may be dangerous before surgery is performed. If The principles of medical therapy in chronic glaucoma are straightforward once the physician has determined the pressure level required for adequate control.This pressure level must, of course, relate to the particular patient and must not be simply some average pressure arrived at by manipulating random population statistics. It is impossible to set rigid guidelines for achieving adequate pressure control but, in general, these should relate to the "functional status" of the patient, since the need for more consistent and lower pressure control increases as his functional status deteriorates. Guidelines for pressure control may thus be roughly related to functional status (Figure, opposite).Brit.

Ocular hypertension--a long-term follow-up of treated and untreated patients.

“…The incidence in a glaucoma clinic population is much higher-according to one report 11 0% (Luntz, 1972). Some authors believe that ocular hypertension represents a preglaucomatous stage (Richardson, 1972;and Goldmann, 1959). Others report on varying degrees of risk of patients with ocular hypertension for developing glaucoma.…”

Επιδραση Της Διατομης Του Οπτικου Νευρου Επι Της Ενδοφθαλμιου Πιεσεως Και Δρασεως Ωσμωτικων Και Μη Διουρητικων Σε Αυτην

“…Ή δευτερογενής υπότονη διούρηση αυξάνεται αυξανομένου τοϋ όγ κου της χορηγούμενης ώσμωτικης ουσίας καί τοϋ μοριακοϋ βάρους αυτής (π.χ. μαννιτόλης), λόγω της δυσκολίας εξόδου της ουσίας άπό τά άγγεϊα και της κινήσεως ύγροϋ άπό τόν έξωαγγειακό προς τόν ένδοαγγειακό χώρο (Richardson 1972, Becker και συν.1968). Ή αποτελεσματικότητα, τών ώσμωτικών παραγόντων στον οφθαλμό οφείλεται, στό ότι αυτοί δέν διέρχονται επαρκώς τους φραγμούς αϊματος-ύδατοειδοΰς (blood-aqueous barrier) και αϊματος-ύαλοειδοΰς (blood-vitreous barrier) καί έτσι, λόγω ώσμωτικής δια φοράς, επέρχεται έξοδος ϋδατος άπό τό υαλοειδές καί δευτερευόν τως άπό τό ύδατοειδές υγρό, τά οποία δρουν σάν αποθήκες ύδατος (water reservoirs), προς τόν ένδοαγγειακό χώρο, μέ αποτέλεσμα την πτώση της ένοοφθαλμίου πιέσεως (Dikstein 1977).…”