Glaucoma : $b A symposium presented at a meeting of the Chicago Ophthalmological Society, November 17, 1913
Science
Glaucoma : $b A symposium presented at a meeting of the Chicago Ophthalmological Society, November 17, 1913
Glaucoma
ring of greater or less width (ectropian uveae). The iris becomes
attached to the pectinate ligament and to the endothelium of Descemet's
membrane. In a very few cases the closure of the angle is not complete
at the apex, a small space remaining comparatively free for a long time.
The adhesion of the iris to the pectinaform ligament and cornea is not
uniform at all parts of the periphery; it varies in width. Portions of
the iris angle may remain open while other parts are closed. Where the
iris tissue lies in contact with the cornea, the stroma of the iris
almost totally disappears. In some cases the iris becomes totally
adherent to the cornea.
_Ciliary Body and Chorioid._ In acute glaucoma there is congestion of
the entire uveal tract, the congestion partaking more of a venous stasis
than of an active or arterial congestion. The vessels of the ciliary
process, which are larger and more tortuous in adults of advanced years
than in the young, become enormously distended, causing almost complete
obliteration of the perilental space. They press against the root of the
iris and the equator of the lens, forcing them forward. There is edema
of the ureal tract, apparently from transudation of serum. Many small,
and sometimes rather large hemorrhages may occur. There is but little
small cell infiltration, indicating almost total absence of what is
ordinarily recognized as true inflammation. It is probable that the
secretion from the glandular zone of the ciliary body is increased.
On subsidence of the congestion, as after miotics or iridectomy, the
tissues may return to very nearly a normal condition. The iris recedes
from contact with the ligamentum pectinatum and cornea and the
filtration angle is again open. In some cases the iris becomes adherent
to the head of the ciliary processes and, when atrophy of the ciliary
body occurs, is drawn backward at the base of the iris by the receding
tissues. If the hypertension persists or is repeated at varying periods,
a slow atrophy of the uveal tract sets in. Eventually the ciliary body
becomes very much reduced in thickness, is flattened out, the ciliary
processes reduced in size and the blood vessels disappear or are reduced
much in caliber. Those that persist possess walls that are much
thickened. This is particularly true of hemorrhagic glaucoma.
In advanced absolute glaucoma the chorioid may become reduced to a very
thin membrane consisting of connective tissue and pigmented cells,
scarcely distinguishable even by moderate powers of the microscope.
Atrophy is marked in the vicinity of the venae vorticosae. Czermak and
Birnbacher describe proliferation of the endothelium of the large veins
with contraction and obliteration of their lumen.
Public-domain text, read in full here on John Shaqi.
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