C Secondary Glaucomas Mechanism of aqueous outflow obstruction

C. Secondary. Glaucomas

● Mechanism of aqueous outflow obstruction in secondary glaucomas: ► Secondary open-angle glaucomas are of the following 3 types: (Fig. next slide) 1. Pre-trabecular in which aqueous outflow is obstructed by a membrane covering the trabeculum. 2. Trabecular where the obstruction occurs within the trabeculum itself. 3. Post-trabecular where the trabeculum itself is normal but aqueous outflow is impaired as a result of elevation of episcleral venous pressure

Mechanisms of aqueous outflow obstruction in secondary glaucomas : (a) pre-trabecular obstruction by a membrane covering the trabeculum (b) Trabecular block by pigment (c) Secondary angle closure by pupil block (d) secondary angle closure not associated with pupil block

Causes of 2 ry Glaucomas (1) Corneal Causes: Causes A. Congenital: flat cornea “corneal plana”, microphthalmos B. Acquired, Acquired including: 1. Hypopyon ulcer 2. Leucoma adherent 3. Anterior staphyloma

(2) Scleral Causes: Causes Scleritis (3) AC Causes: Causes 1. 2. 3. 4. Hyphema esp. total hyphema Hypopyon with corneal ulcer or iritis Epithelial downgrowth after cataract surgery Severe shallowing of AC after glaucoma surgery PAS angle block 5. Anterior dislocation of crystalline lens esp. with pupillary block.

(4) Iris & CB Causes: Causes 1. 2. 3. 4. Iridocyclitis Aniridia ( 2 ry congenital glaucoma) Iris NV (Rubeosis iridis) & NVG Malignant tumors of iris & CB

(5) Lens Causes (lens-induced Glaucoma): Glaucoma) A. Congenital causes: causes Spherophakia Pupillary block 2 ry glaucoma. B. Acquired causes: 1. 2. 3. 4. 5. Phacomorphic glaucoma (Intumscent cataract) Phacolytic glaucoma (Hypermature cataract) Lens subluxation & dislocation Ocular trauma Glaucoma capsularis (Pseudoexfoliation syndrome

(6) Glaucoma 2 ry to fundus lesions: 1. Choroidal & retinal tumors (e. g. retinoblastoma) 2. Persistant hyperplastic primary vitreous (PHPV) 3. Advanced retinopathy of prematurity (ROP) 4. CRVO 5. Retinitis pigmentosa 6. Massive vitreous hemorrhage

(7) 2 ry Glaucoma due to drugs: 1. Mydriatic-induced glaucoma in a patient with narrow angles during refraction or fundus examination 2. Steroid-induced glaucoma

Examples of 2 ry Glaucomas ● Pseudoexfoliative glaucoma ● Pigmentary glaucoma ● Neovascular glaucoma ●Inflammatory glaucomas ● Phacomorphic glaucoma ● Phacolytic Glaucoma ● Red cell Glaucoma ● Ghost cell Glaucoma ● Angle-recession (cleavage) glaucoma

Phacolytic Glaucoma

Intumescent Cataract

Pupillary block after cataract surgery

2 ry glaucoma with AC IOL & pupillary block

Neovascular Glaucoma

Anterior dislocation of cataractous lens

Epithelial downgroth & Glaucoma

Pseudoexfoliation