依流出受阻機轉不同而作的青光眼分類(必考!)
Open-angle
一、Pretrabecular (membrane overgrowth)
NVG, ICE,PPMD (也有機會發生在angle closure)
Fuchs heterochromic iridocyclitis
NV與PAS無關、也不屬於secondary angle-closure
二、 Trabecular (直接阻塞)
Idiopathic : POAG, JOAG
RBC: Ghost cell glaucoma
Pigment : Pigmentary glauacoma, exfoliation syndrome
Protein: uveitic glaucoma, lens-induced glaucoma
Tumor: juvenile xanthogranuloma, metastasis, primary ocular tumors
Viscoelastics: 眼內手術後,viscoat / healon沒吸乾淨
α-chymotrypsin-induced glaucoma
Trabeculum結構改變: steroids, trabeculitis, alkali burn, angle recession IOFB: hemosiderosis, chalcosis
三、 Post-trabecular
C-C fistula
Sturge-Weber syndrome
Mediastinal tumors , retrobulbar tumors
Sup. vena cava syndrome
Thyroid eye
Angle closure
一、 Anterior (Pulling)
ICE, NVG, PPMD
考題:NVG與pupillary block無關!而是與peripheral ant. synechiae相關
Trauma(penetrating or non-penetrating皆可能)
Secondary angle-closure with NV : OIS, CRVO, chronic retinal detachment
二、 Posterior (Pushing)
有pupillary block (考!)
phacomorphic lens
pseudophakia,
intumescent lens
micropherophakia
uveitis
ectopia lentis (如Marfan syndrome)
三、 無pupillary block
PHPV, ROP
Tumors: melanoma, retinoblastoma (記得要掃B-scan)
Anterior chamber angle發育異常
Axenfile-Rieger syndrome
Peters anomaly
補充:
Angle Recession
cleavage between circular and the longitudinal fibers of the ciliary muscle.
Trabeculum往後轉,若範圍夠大,眼壓會升高。