M 6 N G M A T LOM TRONG
H0I CHaNG P H A N T A N SAC TO
THE CONCAVE IRIS IN PIGMENT DISPERSION SYNDROME
Nffriii dich: Nguyin Vin Thdnh*
T 6 M TAT
Myc tiSu: nhdm hinh dung nhihig thay d6i eda du&ng vih mSng mdt & binh nhdn (BN) cd hdi chung phdn tdn sdc to (pigment dispersion syndrome) sau khi nhdy mdt, dieu tiit vd thuoc co dong tu bdng cdch sir dyng OCT bdn phdn truac.
Thi^t ke nghiSn cihi: quan sdt logt tnr&ng hgp (Observational case series).
D6i tuvng: tdng cgng 33 mdt cua 20 BN cd hgi chung phdn tdn sdc to.
Phinrag phfip: mdi mdt dugc chyp dnh dgc theo kinh tuyin ngang tir 0 den 180 dg bdng hi thdng chyp dnh bdn phdn tru&c yisante (Carl Zeiss Meditec, Dublin, CA). Cdc nhdt cdt dugc thfc hiin tgi du&ng chuan vd sau khi Igp trung vdo lieu dfnh vi bin trong trong thai gian 5 phdt. nhdy mdt cudng ip, diiu tiet vd ihudc CO ddng tit pilocarpine 2%.
Cfic s^ do kit qufi chinh: phdn tich dinh lugng nhOng thay ddi hinh dgng mdng mdt.
Ket qufi: sau 5 phut djnh vj liin tyc. mdng mdt tra nen phdng vai dg cong trung binh ± dg lich chudn gidm tir 214 ± 74 fim xudng cdn 67 ± 76 pm (P<0.05). Mdng mdt vdn con phdng & tat cd cdc BN cd hgi chung phdn ldn sdc tdsau khi nhdy mdt cu&ng ep nhung dd ldm mdng mdl hoi phyc tu din 227 ± 113 ^im (P = 0,34) vd 238 ± 119 fim (P = 0,19) vat kinh tuong ung -3.0 vd -6.0 diop. Co ddng tir do Pilocarpine ldm cho mdng mat cd hinh dgng phdng trong tat cd cdc ddi tugng.
Kit lufin: nghien cuu ndy chi ra rdng mdng mdt trong hgi chimg phdn tdn sdc td co hinh dgng phdng khi dfnh vf vd dg lom cua be mgt mdng mdl khdng phyc hdi bai nhdy mdt. Diiu Hit phyc hdi dg ldm mdng mdt cho gid thiil rdng dg ldm sau cua mong mdl trong hgi chung phdn tdn sdc Id dugc tgo ra vd cd thi dugc duy tri, it nhdt timg phdn. b&i diiu liOt.
I. GIOI THI$U ngopi vi vfi sfic to nfiy Ifing dgng khSp ban phfin Hpi chiing phan tfin sfic td (PDS) dflc trung trudc, ki cfi viing b^. Diiu nfiy dan den gia ifing bdi mfit sac id mdng mfll tir vimg gi&a din vimg nhfin fip vfi vi vpy tfing nguy co gidcdm sfic to.
* Binh viin Mdt Binh Dinh
54 I Nhan khoa Viet Nam (SS 27 - 2012)
Tam chiing Ifim sfing thudng g$p trong h0i chiing phfin tfin sfic t6 gom dfii sfic t6 diing dgc trfin n$i md gific mpc trung tfim (hinh thoi Krukenberg), khiem khuyit xuyfin m6ng mfil Ida trdn tii viing giiia din vimg ngopi vi m6ng mfit vfi sfic t6 dfiy dfic d vting b^'. Sy ldm sau ciia m6ng mfit ngopi vi cung cd thi dugc nhin thiy nhung khdng ludn ludn cd mfit d Ihdi diim chdn dofin^ dflc bi^t d BN g6c Phi^ Thdng thudng hon, nd dugc quan sfil lh4y d nhdm trd tu6i, nam gidi c§n thj vfi cQng di kfim vdi hdi chiing gii trdc bao* vfi bong vdng mpc. Nguy co hinh thfinh gidcdm d BN cd hdi chi^g phfin tfin sfic to lfi 10% sau 10 nfim vfi 15%
sau 15 nfim^ nhung theo ihdi gian, b^nh nfiy cd Ihi dn dinh hofic "bien mit"*.
Sfic td phan tfin bfll nguon tir biiu md sfic to mdng mfit sau. Sy ldm sau cua ming mflt lir vimg giiia din vimg ngoai vi cd thfi din din sy tifip xiic vdi day treo Ihfi thuy tinh (hay ggi lfi tifip xiic day treo - mdng mfit) va bong sfic td (pigment shedding)^. Theo thdi gian, sy gia lang sfic t6 cd thi din din nhiing thay ddi tai viing bfi* vdi tflng nhan ap. Nghen ddng tu dfio ngugc RPB (Reverse pupil block) dugc cho lfi nguyfin nhan chinh cua hinh dang mdng mfit ldm.'''"*'*'
Kfit qufi sifiu fim dfi chi ra rflng, sy ldm sau ciia mdng mfit trong mat cd hdi chimg phan tan sflc Id cd thfi dao ngugc vdi su dy phdng bfing nhfiy mfit, thudc CO ddng tu,'" vfi cfit mdng mfit chu bien bflng laser,t'»i *'*i"i nhung gia lang vdi difiu tiit."^i-i"ii"' '^ E'si Mdt vfin dfi tifim nang trong vific khfio sat dg cong mdng mat bang sifiu am lfi kT thupt nfiy can cd sy tiip xiic vdi nhan cfiu bfing each lam nudc (water bath). Diiu nfiy cd kha nang gay thay ddi hinh dpng mdng mfit. OCT bfin phan trudc tpo ra mgt phuang phfip khdng tifip xuc cd dugc nhftng hinh anh cua gdc, nhu md la ciia Leung va cgng sy.'* Chiing toi tim each danh gia gifi trj cua nhung
ddu hifiu cO bfing cfich quan sfit nhttng thay dii eda dudng viin ming mflt cua BN cd h^i chiing phfin tfin sflc t i sau khi nhfiy mfit, diiu tiit vfi Ihuic co ding tii.
U. T A I LIfU VA PHU^ONG PHAPNGHlfeN CtfV 1. Thiit k i nghifin cthi
Dfiy lfi nghifin ciiu quan trfic tiin cihi. Chiing ldi tiin hfinh khfim nhttng BN dugc chdn dofin lam sfing cd hdi chiing phfin tfin sfic t i (sy cd mflt ciia thoi Krukenbeig, khiim khuyit xuyfin mdng mflt tda trdn tir vimg gitta din vung ngopi vi vfi vimg bfi ding nhfit tit viia phfii din d$m dflc sfic li) vfi khdng cd lien sti cfit ming mfit chu bifin bflng laser hay sir dyng thuoc co ddng tii. Tat cfi ddi tugng dugc khfim tiin cihi vfi khfim lam sfing chi tiit bao gdm cfi dfin khe, sol gdc va danh gifi dTa thi. Quy Irinh nghien ciiu dugc chfip thupn bdi Uy ban Dpo dire cua Bfinh vien Tai Mfit Hofing Gia Victoria vfi dugc lifin hanh phii hgp vdi cfic nguyfin tflc dao diic ciia Tuyfin bd Helsinki.
2. Hinh finh OCT ban ph4n trudrc
Hinh finh OCT bfin phfin trudc dugc thuc hifin bfing he Ihdng chyp finh ban phfin trudc Visante (Cari Zeiss Meditec, Dublin, CA) dgc theo kinh tuyin tu 0 dfin 180 do cua mfit trong diiu kifin anh sfing chuan vdi lat cfi anh sfing phdng dugc bpt Ien trudc khi kham. Chyp finh dugc thuc hien sau mdi budc dugc lifit kfi trong phiiu chyp (Hinh 1), trong sudt thdi gian dd BN dugc yeu cfiu Ipp trung nhin vfio tifiu djnh Vf ben trong. Difiu nay dugc theo ddi bdi ngudi kham va man hinh Iheo ddi ddng tu. Difiu tiil dugc lao ra bdi kinh -3,0 didp va rdi -6,0 didp.
Kinh dugc dpi trye tiip trudc mfit va BN dugc yeu cau lap trung nhin vao lieu dinh vi bfin trong trudc khi kinh dugc lfiy di. Co ddng tir bfing thudc dpi dugc bfing 1 gipt pilocarpine 2%.
|M«(klM«M(
\
iiwwiM<rMKr»*M(mM»i*'*")
tOMMMIt(lMldtM«(
( M l
^ HMI
tanl
Wnh 1. Phiiu ch^p dnh
3. Do d$ cong ming mfit
Cfic finh chyp dugc lfiy ra phfin tich trfin phdn mfim Visante. Kich thudc dp cong ming mfit dugc do bfing cfich v5 mpt dudng thfing tCr chfin ming mfit din diim tiip xiic thi thuy linh mong mfil gdn
vdi bd ding tii nhdt vfi rii do khoang cfich vudng gdc tdi da hjr dudng kfi nfiy tdi mdng mit sau"
(Hinh 2). Gifi trj duong linh chi ra sy ldm sau cua mong mfit.
Hinh 2. Kich thudc d^ cong sau eda m&ng mdt dugc do bdng cdch vi mgt dtr&ng thdng tir chdn mdng mdt den diim tiep xdc thi thuy tinh mong mdt gdn v&i b& ddng tu nhat vd
rdi do khodng cdch vudng gdc tii da tit du&ng ki ndy tdi mong mdt sau 15 4. Phan tich thong ke
Dp cong mong mflt cua moi mfil dugc trinh bfiy bang trung binh ± dg Ifich chuan. Phfin tich
thong kfi nhihig thay ddi dd cong so vdi chudn dugc dfinh gia bfing t test cap ddi voi P<0,05 dupc xem lfi cd y nghTa vfi mflt thing ke.
56 I Nhan khoa Viet Nam (So 27 - 2012)
i n . K £ T Q U A
Tdng cdng 33 mfit ctia 20 BN dugc chdn dofin Ifim sfing cd h$i chiing phfin tfin sfic t i dugc dua vfio nghifin clhi. T\iii trung binh eda BN lfi 37,1±I6,4 tuii (tuii tti 18 - 70). Phdn cdn lpi ciia cfic thdng si dfin s i hgc eda BN dugc ting kit trong Bfing 1.
Ming mat 15m ctia 3 BN ddu tifin trd nfin phdng sau 5 phiit diiu tiit c i dinh rii ldm lpi sau khi BN dugc hudng ddn ngii itti ra xa mfiy Visante vfi t^p trung vfio cfic v(lt gdn vfi xa xung quanh phdng. Nhttng BN nfiy sau dd dugc chyp Ipi sii dyng phiiu chyp finh trong Hinh I.
Bdng 1. Ddn sS hgc eda ddn si nghiin cd-u
SiBN s6mit
Nam 13 20
Nit 7 13
"Diii (nim) Tningvi Day
31 18-70
40 19-66 Nhan ip (mmHg)
Trung vi Day
17,5 10-29
19,0 10-27 Tgt khuc xg(D)
Tmng vj Day
-2,50 -4,00 tii+1,00
-1,38 -2,00141 + 0,75 D = Didp
NhOng thay d i i ve d$ cong ming mfit Du lifiu dugc ting kit nhu thanh biiu dd (Hinh 3) vfi cac hmh finh OCT dpi difin rtt nhdm BN dugc chi ra trong Hinh 4. Hinh dpng ming mfit ban ddu lfi ldm trong tdt cfi cac mfit nghien ciiru (Hinh 4A).
Sau 5 phiit diiu tiit c i dinh, khi BN dugc phep nhay mfit ty do, ming mflt cd hinh dpng phflng trong tdt cfi cfic ddi tugng (Hinh 4B) vdi dd cong
gifim tii trung binh 214 ± 74 pm tdi 67 ± 76 pm (/*<0,05). Trong tfit cfi cfic dii tugng tru 1 trudng hgp, nhfiy mflt khdng thfi phyc hdi dg ldm sau ciia mdng mfit (Hinh 4C), vdi dg cong mdng mflt cdn 49 ± 59 |un (/'<0,05). Trong 1 dii tugng, sy lom ra trudc xay ra sau 5 phiit diiu tifit, vdi dd cong mdng mfit thay ddi tut 340 dfin -100 pm, diiu nfiy phuc hdi tdi 15 pm do nhfiy mfit.
aft
w
2B
1 «
lOO CO-4 ^ K y
r^ /
— ^ J 1
^
V \
\7^—^
" - A l^ \
* •
/ / / / / /
Hinh 3. Thanh biiu di chi ta nhihig thay doi df cong mong mil ttung binh.
Cic thanh lech li di l^ch chuin.
Hinh 4. Hinh inh OCT bin phin tru&c cua cung BN chl ra ming mit lim sau so v&l chuin (A) vi phing sau 5 phut dUu tlit dufc kiem soil (B) vi sau khi nhiy mil cu&ng ip (Q. Mong mil tta nin lom, sau khi tgo ta dliu tUl bing kinh -3,0Dvi-6,9D (E). Sau khi nhi pilocarpine, mong mit Iri nen phing (F). Dit&ng lien c\fa cing mfc dufc ding nhu tbi&ng chuin chung glim cic hinh inh.
Dieu ti^t gSn 190 ra bang kinh c4u trir 1 ^ tSng do cong m6ng mil tai 227 ± 113 (rai (/> = 0,34) v4 238 ± 119 pm (/> = 0,19) tuong ling bang kinh-3,0 D vi -6,0 D (Hinh D, E). Trong mi>l (j6i tutmg, do cong mong mat khong the phyc hoi bang didu tiet tao ra boi kinh am v^ s\r cong sau chi trd l^i khi BN duoc yeu ciu ngoi lui ra xa mfiy va t|p trang vio cac v|t gjn v4 xa xung quanh ph6ng. Co dong tiJ do Pilocarpine t^o ra hinh d^ng m6ng mat phing (Hinh 4F) d tit ca cic doi tuong (18 ± 85 (mi, P<0,05).
IV. BAN LUAN
Sir hinh thinh phan tin sic to li do sv bong sic 16 tir vi tri tiSp xuc day treo -mdng mit gay nSn, it nhat timg phan, bdi su 10m sau ciia mong mit.
s i c t6 luu thdng t$p trung tfi vimg be din den tfing nhan ip. Phan (in sic td di kem vdi vj tri bim m6ng mit d phia sau hon lik mfit binh thudng,'^ mong mit kich thudc Idn hon,'" vi day treo trudc dii hon,"
vi xiy ra vdi khi^m khuydt xuyen m6ng mit, trong lijc bieu mo mdng mit sau vin cdn nguyen v ^ . "
Nhihig thay ddi m6ng mit sau di^u tiit, cit ming mit chu bien bing laser va diiu tri co dong tu da duijc ghi hd so bing sieu am li»l.l"ll'!l.li<l.li!l>»pil va OCT bin phin trudc." Nghen dong ta dio nguoc dir^c cho la co chi sinh ly benh gia ting d i ^ tiep xiic thi thiiy tinh -ming mit v i ngSn cin su can bang ip luc gii>a tiin phdng v i h$u phdng. Dieu niy din den ip luc trong tiin phdng ldn hon trong hSu phdng vi giy ra ldm sau ciia ming mit. Nhu viy, diiu gi giy ra nghSn ding tu dio ngugc dSn
58 I Nhan khoa Viet Nam (So 27 - 2012)
din ming mfit ldm sau trong h$i chiing phfin tfin sficti?
Liebmaim vfi c$ng sy" bfio cfio rflng, ming mflt ciia nhChig BN cd hQi chiing phfin tfin sdc t i vfi ciia nhthig BN binh thudng thay dii tit ldm sau din hinh dpng phfing khi nhfiy mfit bj ngfin cfin bdi sy tfim nudc (water bath) dugc diuig \rong sifiu fim vfi diiu tiit dugc kiim sofit. Nlingmfit dfio ngugc din dd cong han ddu kht tfim nudc b) lopi bd vfi nhfiy mfit bfit ddu trij lpi. Ngudi ta gifi thiit rfing, hinh dpng phfing Ifi do cfin bfing fip lyc trong liin phdng vfi h^u phdng Iheo thdi gian vfi nghSn ding tii dfio ngugc xfiy ra khi cd m$t lugng nhd thiiy d)ch dugc fip vfio tifin phdng khi BN nhfiy mfit. Nghifin ciiu ciia chiing tdt chl ra rfing, ming mfit Ird nfin phfing khi BN tiip tyc nhfiy mflt trong liic difiu liil dugc kiim sofit (bflng cfich t$p trung lifin tyc vfio tifiu dinh vi bfin trong). Nd khdng dfio ngugc lpi hinh dpng ban dfiu bfing nhfiy mflt cudng fip vfi chi Ird nfin ldm sau khi difiu tifit dugc tpo ra.
Khi BN difiu tifit, dong tii binh thudng co lpi vfi dudng kinh trudc sau ciia the thiiy tinh gia lang, dfin dfin su di ehuyfin vfi phia trudc ciia thfi tfaiiy tinh, gifim tuong ling dg sau tien phdng,'' va nhiing thay ddi vfi dp cong trudc cua thfi thiiy linh.'' Dieu nay ep thiiy djch vfio gdc ngopi vi vfi lam cho mong mflt dang 15m sau thay dii. Thay dii thfi thiiy tinh ciing cd thi dfin din sy gia tflng difin tiip xiic thfi thiiy tinh - ming mfit, difiu nfiy hopt dgng nhu mgl cfii van cd nfip", ngfin chfin sy can bfing fip lyc giiia tifin phdng vfi hau phdng, duy tri sy nghdn ding tii dfio ngugc. Sy ldm sau ciia mdng mflt cd the xay ra d miic dg nhd d cac BN binh thudng, nhung dfing ki hon d BN cd hgi chiing phan tfin sfic Id.
Difiu nfiy cd the gifii thfch tpi sao mong mfit lom sau trudc dd cd the tdi tfi hon khi BN difiu tifit'' vfi tai sao dg cong sau ciia mdng mfit trong hdi chimg phan tfin sfic td cd thi dugc duy tri bdi nhCmg thay ddi vfi difiu lifit. Sy phyc hdi do ldm mdng mat ngoai vi din hinh thi phfing bdi cfil mdng mflt chu bien bfing laser ["].(2i]vai22] j^ofic difiu Iri co ddng hi'"
din din giam liip xuc thfi thuy tinh - mdng mil",
diiu nfiy khdng thay dii bdi diiu tiit" vfi diiu tri nghfin ding tii dfio ngugc. Diiu nfiy ddn din gifim tiip xfic dSy treo - ming mfit, giim bong sfic t i vfi tin hpi thfim dii vdi viing bfi.
Nhiing thay dii vi kfch thudc thi thdy tinh vfi gifim bifin dd diiu tiit theo thdi gian'* cd thi gifii thich s\f gifim hdi chumg phfin tfin sflc t i theo tuii^
vfi thofii triin ciia bfinh nfiy trong vfii BN.' Trong ldl cfi cfic BN, thi thiiy tinh ty nhifin gia tfing kich Ihudc,^' Ifim cho ming mflt binh thudng cong ra hirdc nhu lfi kit qufi cua nghfin ding hi tuong dii, Ifim gifim difin tiip xiic thi thiiy tinh - ming mfit.
Trong hdi chiing phfin tfin sfic t i , sy gia tfing difin tiip xiic thi thiiy tinh - ming mfit duy tri nghfin ding tii dfio ngugc, dieu nfiy gay nfin sy ldm sau ciia ming mflt, liip xiic dfiy treo - mong mat vfi bong sfic li. Cd the lfi, khi sy tfing trudng thfi thiiy tinh ly nhifin dfin vi tri tifip xiic day treo - mong mflt, nd dfiy ming mfll ra trudc, dieu chinh hinh dang Idm^ vfi gifim tiip xiic dfiy treo - ming mfit, ddn din hinh dang phfing ciia ming mflt. Khi tuii gia tfing, cd su gifim tuong img vfi bifin dd difiu tiit'* difiu nfiy cd thfi cho phep sy cfin bfing fip lyc giiia 2 phdng, dan din nghfin ddng tir dao ngugc it hon.
Sy ldm sau ciia ming mfll din din bong sfic l i dugc cho lfi lifin quan tdi sy yiu kem gifii phlu cua ming mflt. Cac bao cao md hgc chi ra mfit lfi bao biiu md ngofii ciia mdng mfit vdi su mdng di dang kfi cua ldp ngoai cdn lai.^" Hon niia, sy gia tflng cfi vfi s i lugng vfi kich thudc cua cac sgi co dugc phfin finh bfing ldp co tda trdn day hon. Ngudi ta gifi thifit rflng, cd sy Hen quan cua mgt gen anh hudng din mgt vfii khia cpnh phal triin ciia 2/3 giiia cua mfit dfiu nhihig nfim tudi 60.'* Bovell va cgng sy^' mdi dfiy bfio cfio 6 gia dinh d Bflc MT vdi di truyfin trdi, nhung cho tdi nay, gen tpo ra hgi chung phan Ifin sac to vfin chua dugc tim thfiy.
Sy chuyen ddi tir hdi chiing phan tan sac td dfin gidcdm sfic td xap xi vao khofing 10 - 20%.^'' "*
1^*1 Cfic yeu td nguy co ciia sy chuyen ddi nay la tudi Ire hon hofic sy cd mat cua lang nhan ap d
thdi diim chin doin, gidi nam, c4n thi "(ng, thoi Krultenbeig," v i phin tin sic ti ho»t tinh." Phin tin sic ti ho«t tinh He trung bdi gia ting xuyin ming mit, ting sic ti giic m^c ho|U: sv xuit hi{n cic h«t ming mit trin bi m|it ciia thi thiiy tinh t»i difn ding tii. Gandolfi vi Vecchi" chl ra ring, cit ming mit chu bitn bing laser cd thi giim tin suit tang nhan ip, m|U: dti hiiu qui It tfi liuig hon d BN hon 40 tuii.
Di kit lu|n, nghiSn ciiu chiing tdi khing djnh nhOng quan sit khic du?c dinh gii bing siiu im, nhimg chl ra ring di cong sau ciia ming mit trong h$i chting phin tin sic ti duoc duy tri bdi
nhOng thay dii v i diiu l A hoB tt bAi i v nhiiy mil Biin di diiu tiit din din n^Og 0 » y ^ ^^ <<i cong trudc ciia thi thiiy tinll^ Ma niy c i thi ^ thiiy djch vio gdc ngofi vi v i ding thdi thay dii diin tiip xiic thi thiiy tinh - ming m i t Diiu ii ngin c h ^ «/ cin bing i p Itic giOa tiin phdng vi hiu phdng, din din nghin ding tii dio nguvc vi lim cho ming mit lAm sau. Can thiip dfiN c6 hOi chiing phiin tin sic t i bing cit ming mit dm biin bing laser hole diiu trj CO ding tft cd Ihi diiu chlnh hinh dang ming mit ISm v l giim bong sic ti, diiu dd cd thi i n djnh nh9n i p v i giim nguy CO hinh thinh hay tiin triin ciia gidcdm sic ti.
TAI LI$U THAM KHAO
1. R. RITCH AND J.M. LIEBMANN, "Role of ultrasound biomicroscopy in the differentiation of block glaucomas", Curr Opin Ophthalmol 9 (1998), pp. 39-45. View Record in Scopus | Cited By in Scopus (18).
2. W.E. GILLIES AND A.M. BROOKS,
"Clinical features at presentation of anterior segment pigment dispersion syndrome", Clin Experiment Ophthalmol 29 (2(X)1). pp. 125-127.
View Record in Scopus | Cited By in Scopus (11).
3. J. SOWKA, "Pigment dispersion syndrome and pigmentary glaucoma". Optometry 75 (2004), pp. 115-122. Abstract | PDF (7812 K) | View Record in Scopus | Cited By in Scopus (9).
4. R. RITCH, R. MUDUMBAI AND J.M.
LIEBMANN, "Combined exfoliation and pigment dispersion: paradigm of an overlap syndrome".
Ophthalmology 107 (2000), pp. 1004-1008.
Abstract | Article | PDF (166 K) | View Record m Scopus I Cited By in Scopus (8).
5. Y. SIDDIQUI, R.D. TEN HULZEN AND JD. CAMERON ET AL, "What is the risk of developing pigmentary glaucoma from pigment dispersion syndrome?". Am J Ophthalmol 135 (2003), pp. 794-799. Abstract | Article | PDF
(I02K) I View Record in Scopus | Cited By in Scopus (23).
6. J.S. SPEAKMAN, "Pigmenlaiy dispersion", Br J Ophthalmol 65 (1981), pp. 249-2SI. View Record in Scopus | Cited By in Scopus (16).
7. D.G. CAMPBELL, "Pigmenlaiy diqienioo and glaucoma: a new theory". Arch C^yhthabiwlft (1979), pp. 1667-1672. View Record in Scopus 1 Cited By in Scopus (100).
8. J. GOTTANKA, D J l JOHNSON, E GREHN AND E. LUTJEN-DRECOLL. "Histologic findings in pigment dispersion syndrome and pigmentary glaucoma", J Glaucoma IS (2006), pp. 142-ISI.
View Record in Scopus {Cited By in Scopus (6).
9. J.R. KARICKHOFF, "Pigmentary dispersion syndrome and pigmentary glaucoma: a new mechanism concept, a new treabnent, and a new technique". Ophthalmic Surg 23 (1992), pp.
269-277. View Record in Scopus | Cited By in Scopus (63).
10. S.D. POTASH, C. TELLO, J. LIEBMANN AND R. RITCH, "Ultrasound biomiciosca|)y in pigment dispersion syndrome". Ophthalmology 101 (1994), pp. 332-339. View Record in Scopus I Cited By in Scopus (90).
60 I Nhan khoa Viet Nam (SS 27 - 201Z)